MEDICARE: DR. GREGORY A GOLDMAN 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	103TC0700X	Clinical Psychologist	2010030791	MO

General Provider Information

NPI Number	:	1952634347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY A GOLDMAN PH.D.

Provider Business Mailing Address
First Line	:	7110 OAKLAND AVE
Second Line	:	SUITE 105
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-1868
Country	:	US
Telephone Number	:	314-884-0779
Fax Number	:	314-227-9327

Provider Business Practice Location Address
First Line	:	7110 OAKLAND AVE
Second Line	:	SUITE 105
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-1868
Country	:	US
Telephone Number	:	314-884-0779
Fax Number	:	314-227-9327

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

Provider Enumeration Date	:	09/16/2009
Last Update Date	:	11/19/2024

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