Healthcare Provider Details

I. General information

NPI: 1952706384
Provider Name (Legal Business Name): GOLDENWOOD SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 S EAGLE RD SUITE 335
NEWTOWN PA
18940-1546
US

IV. Provider business mailing address

2865 S EAGLE RD SUITE 335
NEWTOWN PA
18940-1546
US

V. Phone/Fax

Practice location:
  • Phone: 215-479-6439
  • Fax:
Mailing address:
  • Phone: 215-479-6439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS005263L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY GOLD
Title or Position: MEMBER
Credential: PH.D.
Phone: 215-479-6439