=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881681575
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT HOWARD GOLDSTEIN PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 WINTON RD S BLDG 4, SUITE 303
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14618-3970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-473-7110
-----------------------------------------------------
Fax | 585-473-3741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 HORSESHOE LN S
-----------------------------------------------------
City | HENRIETTA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14467-9706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-334-4557
-----------------------------------------------------
Fax | 585-473-3741
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 2192
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------