Provider Demographics
NPI:1205882818
Name:GOLDBERG, CLAIR L (PSYD)
Entity type:Individual
Prefix:DR
First Name:CLAIR
Middle Name:L
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 PLYMOUTH ST STE 208
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2677
Mailing Address - Country:US
Mailing Address - Phone:973-744-1600
Mailing Address - Fax:973-744-3305
Practice Address - Street 1:33 PLYMOUTH ST STE 208
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2677
Practice Address - Country:US
Practice Address - Phone:973-744-1600
Practice Address - Fax:973-744-3305
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4139103T00000X
NY014263-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist