=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245351311
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUSTINE CANCILLA GOLDEN PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 HILLSIDE AVE STE G
-----------------------------------------------------
City | WILLISTON PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11596-2311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-625-0361
-----------------------------------------------------
Fax | 516-625-0361
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 PARKWAY DR
-----------------------------------------------------
City | ROSLYN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11577-2706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-801-4287
-----------------------------------------------------
Fax | 516-625-0361
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 015842-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC2200X
-----------------------------------------------------
Taxonomy Name | Clinical Child & Adolescent Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | 1809419
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------