Provider Demographics
NPI:1952610735
Name:GOLDBERG CONSULTING GROUP, INC.
Entity Type:Organization
Organization Name:GOLDBERG CONSULTING GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:AZ PHSYCHOLOGIST
Authorized Official - Phone:480-831-0746
Mailing Address - Street 1:600 E BASELINE RD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1247
Mailing Address - Country:US
Mailing Address - Phone:480-831-0746
Mailing Address - Fax:
Practice Address - Street 1:600 E BASELINE RD
Practice Address - Street 2:SUITE C-1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1247
Practice Address - Country:US
Practice Address - Phone:480-831-0746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 1045103TC1900X, 103TC2200X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty