Provider Demographics
NPI:1265196224
Name:GOLDEN, TATIANA VICTORIA
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:VICTORIA
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 TRINITY AVE APT 11B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-7430
Mailing Address - Country:US
Mailing Address - Phone:347-575-0826
Mailing Address - Fax:
Practice Address - Street 1:307 W 38TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-9537
Practice Address - Country:US
Practice Address - Phone:212-696-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator