1457426892 NPI number — CLIFFORD S GOLDEN EDD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457426892 NPI number — CLIFFORD S GOLDEN EDD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLIFFORD S GOLDEN EDD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457426892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3531 THOMAS STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33021-3611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-961-5987
Provider Business Mailing Address Fax Number:
954-433-0603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10000 STERLING ROAD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
COOPER CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33024-8067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-436-8326
Provider Business Practice Location Address Fax Number:
954-433-0603
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDEN
Authorized Official First Name:
CLIFFORD
Authorized Official Middle Name:
STEPHAN
Authorized Official Title or Position:
CORPORATE PRESIDENT PSYCHOLOGIST
Authorized Official Telephone Number:
954-436-8326

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PY4079 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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