Provider Demographics
NPI:1457426892
Name:CLIFFORD S GOLDEN EDD PA
Entity type:Organization
Organization Name:CLIFFORD S GOLDEN EDD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:STEPHAN
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYCHOLOGIST EDD PY
Authorized Official - Phone:954-436-8326
Mailing Address - Street 1:3531 THOMAS STREET
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3611
Mailing Address - Country:US
Mailing Address - Phone:954-961-5987
Mailing Address - Fax:954-433-0603
Practice Address - Street 1:10000 STERLING ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33024-8067
Practice Address - Country:US
Practice Address - Phone:954-436-8326
Practice Address - Fax:954-433-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4079103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73377Medicare ID - Type Unspecified
=========Medicare UPIN