MEDICARE: DR. ALAN CHARLES GOLDBERG ED.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	103T00000X	Psychologist	MA3242	MA

General Provider Information

NPI Number	:	1801958533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN CHARLES GOLDBERG ED.D.

Provider Business Mailing Address
First Line	:	14 MARY ANNE DR
Second Line	:
City	:	FRANKLIN
State	:	MA
Zip	:	02038-2650
Country	:	US
Telephone Number	:	508-533-4653
Fax Number	:	508-533-4653

Provider Business Practice Location Address
First Line	:	844 FRANKLIN ST
Second Line	:	# 7
City	:	WRENTHAM
State	:	MA
Zip	:	02093-1223
Country	:	US
Telephone Number	:	508-384-0777
Fax Number	:	508-533-4653

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

Provider Enumeration Date	:	12/16/2006
Last Update Date	:	07/08/2007

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