Healthcare Provider Details

I. General information

NPI: 1821503236
Provider Name (Legal Business Name): THEODORE JAMES GOLDSMITH PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 W 34TH ST FL 3
LOS ANGELES CA
90089
US

IV. Provider business mailing address

221 WESTWOOD PLAZA, SUITE 2437 BOX 951556
LOS ANGELES CA
90095-1556
US

V. Phone/Fax

Practice location:
  • Phone: 213-740-7711
  • Fax: 213-740-6815
Mailing address:
  • Phone: 310-825-0768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY29425
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: