Basic Information
Provider Information
NPI: 1265782577
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VANHEEL
FirstName: GOLDIE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PSYD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1385 MISSION ST
Address2: 240
City: SAN FRANCISCO
State: CA
PostalCode: 941032623
CountryCode: US
TelephoneNumber: 4158644002
FaxNumber: 4158647093
Practice Location
Address1: 3825 HOPYARD RD
Address2:  
City: PLEASANTON
State: CA
PostalCode: 945888528
CountryCode: US
TelephoneNumber: 4156152165
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/13/2012
LastUpdateDate: 11/11/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X30845CAY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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