Provider Demographics
NPI:1841956919
Name:ROOD GOLDMAN, REBECCA MOLLY (PMHNP)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:MOLLY
Last Name:ROOD GOLDMAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 OCEANVIEW RD
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1021
Mailing Address - Country:US
Mailing Address - Phone:201-874-5646
Mailing Address - Fax:
Practice Address - Street 1:158 OCEANVIEW RD
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1021
Practice Address - Country:US
Practice Address - Phone:201-874-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403814363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health