Provider Demographics
NPI:1750373742
Name:RUPP-GOOLNICK, ARLENE H (PHD)
Entity type:Individual
Prefix:DR
First Name:ARLENE
Middle Name:H
Last Name:RUPP-GOOLNICK
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 1:769 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:N WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3527
Mailing Address - Country:US
Mailing Address - Phone:516-791-5350
Mailing Address - Fax:212-925-2935
Practice Address - Street 1:769 WILSON ST
Practice Address - Street 2:
Practice Address - City:N WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11581-3527
Practice Address - Country:US
Practice Address - Phone:516-791-5350
Practice Address - Fax:212-925-2935
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8459103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0046276OtherGHI
NY00994638Medicaid
NYV94001Medicare ID - Type Unspecified