MEDICARE: DR. CHARLES JOSH GOLDEN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	PY5226	FL

General Provider Information

NPI Number	:	1073696852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES JOSH GOLDEN PH.D.

Provider Business Mailing Address
First Line	:	2862 NE 35TH CT
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-8574
Country	:	US
Telephone Number	:	954-262-5715
Fax Number	:	954-283-8655

Provider Business Practice Location Address
First Line	:	3301 COLLEGE AVENUE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33314
Country	:	US
Telephone Number	:	954-262-5715
Fax Number	:	954-283-8655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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