=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588723878
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDSMITH PSYCHOLGICAL ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 SHADY AVE SUITE C207
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15206-4409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-363-8779
-----------------------------------------------------
Fax | 412-363-9727
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 SHADY AVE SUITE C207
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15206-4409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-363-8779
-----------------------------------------------------
Fax | 412-363-9727
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DAVID S GOLDSMITH
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 412-363-8779
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PS-004795-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------