Provider Demographics
NPI:1952634347
Name:GOLDMAN, GREGORY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 OAKLAND AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1868
Mailing Address - Country:US
Mailing Address - Phone:314-884-0779
Mailing Address - Fax:314-227-9327
Practice Address - Street 1:7110 OAKLAND AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1868
Practice Address - Country:US
Practice Address - Phone:314-884-0779
Practice Address - Fax:314-227-9327
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010030791103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical