Provider Demographics
NPI:1932255106
Name:GOLOMB, ANATH CHANA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANATH
Middle Name:CHANA
Last Name:GOLOMB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-2100
Mailing Address - Country:US
Mailing Address - Phone:603-868-1619
Mailing Address - Fax:
Practice Address - Street 1:539 ISLINGTON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4225
Practice Address - Country:US
Practice Address - Phone:603-431-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH762103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent