Healthcare Provider Details

I. General information

NPI: 1255514857
Provider Name (Legal Business Name): MS. SARA ELLEN GOOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MADISON AVE STE 629
NEW YORK NY
10016-1155
US

IV. Provider business mailing address

53 WELLSFORD DR
GOSHEN CT
06756-1817
US

V. Phone/Fax

Practice location:
  • Phone: 203-247-9305
  • Fax:
Mailing address:
  • Phone: 203-247-9305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number000781
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number000781
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: