MEDICARE: DR. ELANA CHANA GOLDMINTZ-GOTFRIED PSY.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	103TC0700X	Clinical Psychologist	PS017357	PA

General Provider Information

NPI Number	:	1609149327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELANA CHANA GOLDMINTZ-GOTFRIED PSY.D.

Provider Business Mailing Address
First Line	:	6060 RIDGE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-1657
Country	:	US
Telephone Number	:	856-448-4487
Fax Number	:

Provider Business Practice Location Address
First Line	:	6060 RIDGE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-1657
Country	:	US
Telephone Number	:	856-448-4487
Fax Number	:

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

Provider Enumeration Date	:	02/10/2012
Last Update Date	:	03/29/2026

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