Provider Demographics
NPI:1255569000
Name:GOLDSTEIN, IRA (MA)
Entity type:Individual
Prefix:MR
First Name:IRA
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ST.AUSTIN'S PL.
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1540
Mailing Address - Country:US
Mailing Address - Phone:718-720-8849
Mailing Address - Fax:347-532-1324
Practice Address - Street 1:14 ST.AUSTIN'S PL.
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1540
Practice Address - Country:US
Practice Address - Phone:718-720-8849
Practice Address - Fax:347-532-1324
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000342-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist