Healthcare Provider Details

I. General information

NPI: 1073578761
Provider Name (Legal Business Name): LYNNE G. GOLDMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SHCC, 1 FLETCHER DRIVE
GAINESVILLE FL
32611-7500
US

IV. Provider business mailing address

10 SW 101ST CT
GAINESVILLE FL
32607-1371
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-1171
  • Fax: 352-846-1030
Mailing address:
  • Phone: 352-392-1171
  • Fax: 352-846-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH6191
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: