=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235568825
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOSHEN PSYCHOLOGY, PLLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2013
-----------------------------------------------------
Last Update Date | 11/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 MAIN ST
-----------------------------------------------------
City | GOSHEN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10924-1638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-294-4241
-----------------------------------------------------
Fax | 845-294-4241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 305 MAIN ST
-----------------------------------------------------
City | GOSHEN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10924-1638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-294-4241
-----------------------------------------------------
Fax | 845-294-4241
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DEBRA KLINGER-ROSENFELD
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 845-294-4241
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 013072NYS
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------