Provider Demographics
NPI:1881714608
Name:GOLDMAN, HEATHER ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ANN
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:115 W 86TH ST
Mailing Address - Street 2:APT. #1F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3410
Mailing Address - Country:US
Mailing Address - Phone:212-362-0867
Mailing Address - Fax:914-591-4225
Practice Address - Street 1:1 BRIDGE ST
Practice Address - Street 2:SUITE #24
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-1543
Practice Address - Country:US
Practice Address - Phone:914-591-0106
Practice Address - Fax:914-591-4225
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015529-3103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV635V1Medicare ID - Type UnspecifiedEMPIRE MEDICARE SERVICES