Provider Demographics
NPI:1801104831
Name:GOLDWASER, GAL (PHD)
Entity type:Individual
Prefix:DR
First Name:GAL
Middle Name:
Last Name:GOLDWASER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:GALI
Other - Middle Name:N/A
Other - Last Name:GOLDWASER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:950 BOARDWALK
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2600
Mailing Address - Country:US
Mailing Address - Phone:760-855-6355
Mailing Address - Fax:
Practice Address - Street 1:950 BOARDWALK
Practice Address - Street 2:SUITE 304
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2600
Practice Address - Country:US
Practice Address - Phone:760-855-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22941103T00000X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral