Provider Demographics
NPI:1245305200
Name:HENRY L. GOLDSTEIN, PSY.D., LLC
Entity type:Organization
Organization Name:HENRY L. GOLDSTEIN, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:203-439-0130
Mailing Address - Street 1:609 W JOHNSON AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-4502
Mailing Address - Country:US
Mailing Address - Phone:203-439-0130
Mailing Address - Fax:203-439-0130
Practice Address - Street 1:609 W JOHNSON AVE STE 108
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-4502
Practice Address - Country:US
Practice Address - Phone:203-439-0130
Practice Address - Fax:203-651-7840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002603103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03287Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID