MEDICARE: GOLD COAST PSYCHOLOGICAL SERVICES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1184518664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLD COAST PSYCHOLOGICAL SERVICES, PC

Provider Business Mailing Address
First Line	:	220 9TH ST
Second Line	:	STE 282
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4288
Country	:	US
Telephone Number	:	201-477-0095
Fax Number	:	201-353-2318

Provider Business Practice Location Address
First Line	:	220 9TH ST STE 2041
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4288
Country	:	US
Telephone Number	:	201-733-4277
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MIRIAM BURT
Credential	:	PSYD
Telephone Number	:	201-477-8193

Provider Enumeration Date	:	06/07/2025
Last Update Date	:	07/24/2025

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