Provider Demographics
NPI:1245351311
Name:GOLDEN, JUSTINE CANCILLA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:CANCILLA
Last Name:GOLDEN
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 1:8 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2706
Mailing Address - Country:US
Mailing Address - Phone:516-801-4287
Mailing Address - Fax:516-625-0361
Practice Address - Street 1:105 HILLSIDE AVE
Practice Address - Street 2:STE G
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2311
Practice Address - Country:US
Practice Address - Phone:516-625-0361
Practice Address - Fax:516-625-0361
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015842-1103T00000X
103TC2200X
NY1809419103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool