MEDICARE: DR. SAM GOLDSTEIN PH.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
1	103G00000X	Clinical Neuropsychologist	110924-2501	UT
2	103TC0700X	Clinical Psychologist	110924-2501	UT

General Provider Information

NPI Number	:	1790745248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAM GOLDSTEIN PH.D.

Provider Business Mailing Address
First Line	:	230 S 500 E
Second Line	:	SUITE 100
City	:	SLC
State	:	UT
Zip	:	84102-2015
Country	:	US
Telephone Number	:	801-532-1484
Fax Number	:	801-532-1486

Provider Business Practice Location Address
First Line	:	230 S 500 E
Second Line	:	SUITE 100
City	:	SLC
State	:	UT
Zip	:	84102-2015
Country	:	US
Telephone Number	:	801-532-1484
Fax Number	:	801-532-1486

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	09/11/2025

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Directions to “ DR. SAM GOLDSTEIN PH.D.” Practice Location

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