MEDICARE: DR. BRYAN GOLDIN

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	PY11183	FL
2	103TB0200X	Cognitive & Behavioral Psychologist	PY11183	FL
3	103TC0700X	Clinical Psychologist	PY11183	FL
4	103TP2701X	Group Psychotherapy Psychologist	PY11183	FL

General Provider Information

NPI Number	:	1518623529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN GOLDIN

Provider Business Mailing Address
First Line	:	800 CORAL RIDGE DR APT 103
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-4134
Country	:	US
Telephone Number	:	954-235-6113
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 N UNIVERSITY DR STE 202
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4636
Country	:	US
Telephone Number	:	954-288-9393
Fax Number	:

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

Provider Enumeration Date	:	11/14/2021
Last Update Date	:	01/15/2022

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Directions to “ DR. BRYAN GOLDIN ” Practice Location

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