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General NPI Number Information
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NPI Number | 1689610875
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Entity Type | Individual
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Provider Name | KEITH GOLIN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 659 EAGLE ROCK AVE STE 4
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City | WEST ORANGE
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State | NJ
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Zip | 07052-2138
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Country | US
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Telephone | 888-284-2034
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Fax | 973-992-4639
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Provider Business Mailing Address
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Address Line | 18 ASPEN DR
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City | LIVINGSTON
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State | NJ
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Zip | 07039-1432
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Country | US
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Telephone | 888-284-2034
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Fax | 973-992-4639
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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 | 35SI0040990
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License Number State | NJ
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