Basic Information
| Provider Information | |||||||||
| NPI: | 1598792905 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDBERG | ||||||||
| FirstName: | ALAN | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 JEFFERSON ST. | ||||||||
| Address2: | STE. 2C | ||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173790496 | ||||||||
| FaxNumber: | 6178070958 | ||||||||
| Practice Location | |||||||||
| Address1: | 1518 WALNUT ST. | ||||||||
| Address2: | STE. 804 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153999764 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 03/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PS004179L | PA | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | PS.004179-L | PA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.