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General NPI Number Information
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NPI Number | 1659694974
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Entity Type | Individual
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Provider Name | LISA GOLDMAN PSYD, MS
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Gender | Female
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 11500 OLIVE BLVD STE 128
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7126
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Country | US
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Telephone | 314-605-7612
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Fax |
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Provider Business Mailing Address
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Address Line | 10 MIDPARK LN
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1557
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Country | US
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Telephone | 314-605-7612
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Fax |
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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 | 0712010118186
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License Number State | IL
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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 | 2011032874
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License Number State | MO
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