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NPI Code Detail

MEDICARE: DR. TINA R GOLDSMITH PH.D., BCBA-D

MEDICARE: DR. TINA R GOLDSMITH PH.D., BCBA-D
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
1103TC0700XClinical Psychologist1155NM
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1518274182
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TINA R GOLDSMITH PH.D., BCBA-D
Provider Business Mailing Address
First Line : 3250 TRINITY DR STE D-3
Second Line :
City : LOS ALAMOS
State : NM
Zip : 87544-2226
Country : US
Telephone Number : 505-412-4044
Fax Number :
Provider Business Practice Location Address
First Line : 3250 TRINITY DR STE D-3
Second Line :
City : LOS ALAMOS
State : NM
Zip : 87544-2226
Country : US
Telephone Number : 505-412-4044
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2010
Last Update Date : 11/17/2016

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