Provider Demographics
NPI:1700951159
Name:GOLDSMITH, LAUREN ROSEANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ROSEANN
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1209
Mailing Address - Country:US
Mailing Address - Phone:303-931-3021
Mailing Address - Fax:303-444-0366
Practice Address - Street 1:350 BROADWAY ST
Practice Address - Street 2:STE 210
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-3338
Practice Address - Country:US
Practice Address - Phone:303-449-4496
Practice Address - Fax:303-444-0366
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2397103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO65920023Medicaid
CO65920023Medicaid
COC478858Medicare PIN