Provider Demographics
NPI:1649783408
Name:GOLDSTEIN, PERLA EDITH (BCBA/LBS)
Entity type:Individual
Prefix:MRS
First Name:PERLA
Middle Name:EDITH
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:BCBA/LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1728
Mailing Address - Country:US
Mailing Address - Phone:914-837-2813
Mailing Address - Fax:
Practice Address - Street 1:2000 ASH ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1546
Practice Address - Country:US
Practice Address - Phone:570-871-4751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001602103K00000X
PABH003414103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty