Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 11337 | MA |
Y | 103TC0700X | Clinical Psychologist | 11337 | MA |
NPI | 1003410929 |
---|---|
Provider Name | Dr. Michael R Goldstein |
First Address | Boston, MA 02215-5491 |
Second Address | Boston, MA 02215-5491 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2020 |
Last Update Date | 23/11/2020 |