Provider Demographics
NPI:1841493772
Name:RUTH GOLDBERG PHD LICENSED PSYCHOLOGIST PC
Entity type:Organization
Organization Name:RUTH GOLDBERG PHD LICENSED PSYCHOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ARLEEN
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:914-423-1104
Mailing Address - Street 1:29 WILLIAMSBURG CLOSE
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-6025
Mailing Address - Country:US
Mailing Address - Phone:914-423-1104
Mailing Address - Fax:914-380-6477
Practice Address - Street 1:29 WILLIAMSBURG CLOSE
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-6025
Practice Address - Country:US
Practice Address - Phone:914-423-1104
Practice Address - Fax:914-380-6477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013750-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVE1631Medicare ID - Type Unspecified