Provider Demographics
NPI:1801958533
Name:GOLDBERG, ALAN CHARLES (EDD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:CHARLES
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MARY ANNE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-2650
Mailing Address - Country:US
Mailing Address - Phone:508-533-4653
Mailing Address - Fax:508-533-4653
Practice Address - Street 1:844 FRANKLIN ST
Practice Address - Street 2:# 7
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1223
Practice Address - Country:US
Practice Address - Phone:508-384-0777
Practice Address - Fax:508-533-4653
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA3242103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO3329Medicare ID - Type Unspecified