Organization
PHYLLIS H. GOLTRA, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHYLLIS H. GOLTRA PH.D. (PRESIDENT)
(215) 545-8441
Entity
Organization
Contact information
Practice address
1616 WALNUT ST, SUITE 1616, PHILADELPHIA, PA 19103-5313
(215) 545-8441
(215) 985-1129
Mailing address
1616 WALNUT ST, SUITE 1616, PHILADELPHIA, PA 19103-5313
(215) 545-8441
(215) 985-1129
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS006504L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7244008
—
PA
Enumeration date
04/19/2006
Last updated
06/01/2009
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