=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669561510
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT J. GOLDSWORTHY, PH.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2006
-----------------------------------------------------
Last Update Date | 07/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | SCOTTSDALE PSYCHOLOGICAL ASSOCIATES 11000 N. SCOTTSDALE RD., STE 163
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-922-5440
-----------------------------------------------------
Fax | 480-922-5445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | SCOTTSDALE PSYCHOLOGICAL ASSOCIATES 11000 N. SCOTTSDALE RD., STE 163
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-922-5440
-----------------------------------------------------
Fax | 480-922-5445
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT J. GOLDSWORTHY
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 480-922-5440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 908
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 908
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------