MEDICARE: CLIFFORD S GOLDEN EDD PA

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	103T00000X	Psychologist	PY4079	FL

General Provider Information

NPI Number	:	1457426892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLIFFORD S GOLDEN EDD PA

Provider Business Mailing Address
First Line	:	3531 THOMAS STREET
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3611
Country	:	US
Telephone Number	:	954-961-5987
Fax Number	:	954-433-0603

Provider Business Practice Location Address
First Line	:	10000 STERLING ROAD
Second Line	:	SUITE 6
City	:	COOPER CITY
State	:	FL
Zip	:	33024-8067
Country	:	US
Telephone Number	:	954-436-8326
Fax Number	:	954-433-0603

Authorized Official
Title or Position	:	CORPORATE PRESIDENT PSYCHOLOGIST
Name	:	DR. CLIFFORD STEPHAN GOLDEN
Credential	:	PSYCHOLOGIST EDD PY
Telephone Number	:	954-436-8326

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	08/22/2020

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