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General NPI Number Information
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NPI Number | 1053335232
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Entity Type | Individual
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Provider Name | HENRY J. GOETZE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 100 W. BEAVER CREEK BLVD SUITE 218
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City | AVON
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State | CO
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Zip | 81620-8572
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Country | US
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Telephone | 845-594-4692
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Fax | 845-471-1815
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Provider Business Mailing Address
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Address Line | PO BOX 8572 100 W. BEAVER CREEK BLVD, SUITE 218
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City | AVON
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State | CO
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Zip | 81620-8572
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Country | US
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Telephone | 845-594-4692
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Fax | 845-471-1815
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 007274
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3047
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License Number State | CO
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