Healthcare Provider Details

I. General information

NPI: 1730093105
Provider Name (Legal Business Name): SAMANTHA GOLDMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 CLARKSON AVE
BROOKLYN NY
11203-2125
US

IV. Provider business mailing address

PO BOX 471607
BROOKLYN NY
11247-1607
US

V. Phone/Fax

Practice location:
  • Phone: 718-221-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: