Healthcare Provider Details

I. General information

NPI: 1952610735
Provider Name (Legal Business Name): GOLDBERG CONSULTING GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E BASELINE RD SUITE C-1
TEMPE AZ
85283-1247
US

IV. Provider business mailing address

600 E BASELINE RD SUITE C-1
TEMPE AZ
85283-1247
US

V. Phone/Fax

Practice location:
  • Phone: 480-831-0746
  • Fax:
Mailing address:
  • Phone: 480-831-0746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberAZ 1045
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberAZ 1045
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberAZ 1045
License Number StateAZ

VIII. Authorized Official

Name: DR. KENNETH J GOLDBERG
Title or Position: PRESIDENT
Credential: AZ PHSYCHOLOGIST
Phone: 480-831-0746