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General NPI Number Information
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NPI Number | 1245305200
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Entity Type | Organization
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Legal Business Name | HENRY L. GOLDSTEIN, PSY.D., LLC
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 12/28/2018
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Provider Practice Location Address
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Address Line | 609 W JOHNSON AVE STE 108
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City | CHESHIRE
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State | CT
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Zip | 06410-4502
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Country | US
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Telephone | 203-439-0130
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Fax | 203-651-7840
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Provider Business Mailing Address
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Address Line | 609 W JOHNSON AVE STE 108
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City | CHESHIRE
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State | CT
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Zip | 06410-4502
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Country | US
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Telephone | 203-439-0130
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Fax | 203-439-0130
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. HENRY L GOLDSTEIN
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Credential | PSY.D.
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Telephone | 203-439-0130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 002603
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License Number State | CT
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