MEDICARE: DENISE GOLDSMITH PHD

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	2630572501	UT

General Provider Information

NPI Number	:	1639263163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE GOLDSMITH PHD

Provider Business Mailing Address
First Line	:	5383 S 900 E STE 290
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-7268
Country	:	US
Telephone Number	:	801-263-3335
Fax Number	:	801-263-2845

Provider Business Practice Location Address
First Line	:	5383 S 900 E STE 290
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-7268
Country	:	US
Telephone Number	:	801-263-3335
Fax Number	:	801-263-3335

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	03/17/2018

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