Healthcare Provider Details

I. General information

NPI: 1982568812
Provider Name (Legal Business Name): JESSICA PILAR REIDER-GOLDMAN ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA GOLDMAN ATR

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SPANISH RIVER DR
OCEAN RIDGE FL
33435-3346
US

IV. Provider business mailing address

15 SPANISH RIVER DR
OCEAN RIDGE FL
33435-3346
US

V. Phone/Fax

Practice location:
  • Phone: 917-538-5952
  • Fax:
Mailing address:
  • Phone: 917-538-5952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number23-101
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: