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General NPI Number Information
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NPI Number | 1720108962
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Entity Type | Individual
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Provider Name | STEPHEN ALAN GOLDBERG PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8018 BUSTLETON AVE. 2ND FLR.
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City | PHILA.
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State | PA
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Zip | 19152-2802
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Country | US
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Telephone | 215-742-6773
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Fax | 215-742-5829
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Provider Business Mailing Address
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Address Line | 220 WARING RD
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City | ELKINS PARK
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State | PA
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Zip | 19027-2125
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Country | US
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Telephone | 215-635-3448
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Fax | 215-635-3448
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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 | PS003906-L
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License Number State | PA
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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 | SI02393
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License Number State | NJ
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