Provider Demographics
NPI:1336848050
Name:GOLDSTEIN, ELISHA TAL (PSYD)
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:TAL
Last Name:GOLDSTEIN
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 1:1757 MERRICK AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2717
Mailing Address - Country:US
Mailing Address - Phone:516-247-6449
Mailing Address - Fax:
Practice Address - Street 1:1757 MERRICK AVE STE 106
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2717
Practice Address - Country:US
Practice Address - Phone:516-247-6449
Practice Address - Fax:516-407-2898
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012413-01103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist