Healthcare Provider Details

I. General information

NPI: 1083045249
Provider Name (Legal Business Name): STACY GOLMAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY BLVD UNIVERSITY OF MISSOURI - ST. LOUIS
SAINT LOUIS MO
63121-4400
US

IV. Provider business mailing address

1 UNIVERSITY BLVD UNIVERSITY OF MISSOURI - ST. LOUIS
SAINT LOUIS MO
63121-4400
US

V. Phone/Fax

Practice location:
  • Phone: 314-516-5824
  • Fax: 314-516-5347
Mailing address:
  • Phone: 314-516-5824
  • Fax: 314-516-5347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2013040102
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: