Basic Information
| Provider Information | |||||||||
| NPI: | 1649311432 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRISON GOLDMAN | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | ED.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 BIRD RD | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020481602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083391628 | ||||||||
| FaxNumber: | 4015210035 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 ROCKLAND RD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198033607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026514200 | ||||||||
| FaxNumber: | 3026514543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PS00805 | RI | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103G00000X | PS00805 | RI | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103TC0700X | B1-0001121 | DE | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.