Healthcare Provider Details

I. General information

NPI: 1053749259
Provider Name (Legal Business Name): LORI GOLDIN M.A., LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 E NEWELL ST
WHITE CLOUD MI
49349-8795
US

IV. Provider business mailing address

1049 E NEWELL ST
WHITE CLOUD MI
49349-8795
US

V. Phone/Fax

Practice location:
  • Phone: 231-689-7330
  • Fax: 231-689-7345
Mailing address:
  • Phone: 231-689-7330
  • Fax: 231-689-7345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301013827
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: