Healthcare Provider Details

I. General information

NPI: 1043736929
Provider Name (Legal Business Name): DAVID S GOLDMAN BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 QUARTERMASTER CT
JEFFERSONVILLE IN
47130-3670
US

IV. Provider business mailing address

3500 DEPAUW BLVD STE 3070
INDIANAPOLIS IN
46268-6135
US

V. Phone/Fax

Practice location:
  • Phone: 812-258-9802
  • Fax: 765-450-6664
Mailing address:
  • Phone: 317-449-4833
  • Fax: 765-450-6664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: