Individual
MR. MICHAEL W GOLDBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
113 HAWK DRIVE, DULCE, NM 87528
(505) 759-2954
(505) 759-1349
Mailing address
98 BULL ELK PL, PAGOSA SPRINGS, CO 81147-8511
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
308194
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
27087859
—
NM
Enumeration date
03/07/2007
Last updated
07/08/2007
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