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NPI Code Detail

MEDICARE: GOLDBERG PSYCHOLOGICAL SERVICES, PLLC

MEDICARE: GOLDBERG PSYCHOLOGICAL SERVICES, PLLC
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
1103T00000XPsychologist

General Provider Information

NPI Number : 1588130413
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOLDBERG PSYCHOLOGICAL SERVICES, PLLC
Provider Business Mailing Address
First Line : 6060 N CENTRAL EXPY STE 500
Second Line :
City : DALLAS
State : TX
Zip : 75206-5249
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6060 N CENTRAL EXPY STE 500
Second Line :
City : DALLAS
State : TX
Zip : 75206-5249
Country : US
Telephone Number : 314-620-8181
Fax Number :
Authorized Official
Title or Position : CHIEF PSYCHOLOGIST
Name : DR. KEVIN GOLDBERG
Credential : PSY.D.
Telephone Number : 314-620-8181
Provider Enumeration Date : 10/18/2018
Last Update Date : 10/18/2018

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