Provider Demographics
NPI:1770981235
Name:GOLDMAN, HEATHER (EDS)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 WARRENSVILLE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-4134
Mailing Address - Country:US
Mailing Address - Phone:216-295-7710
Mailing Address - Fax:
Practice Address - Street 1:4270 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2812
Practice Address - Country:US
Practice Address - Phone:216-336-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2969236103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool