Individual
CLARK R. GOLDSTEIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1981 MARCUS AVENUE, SUITE C-102 NYU CHILD STUDY CENTER, LAKE SUCCESS, NY 11042
(516) 358-1808
(646) 754-9854
Mailing address
1981 MARCUS AVENUE, SUITE C-102 NYU CHILD STUDY CENTER, LAKE SUCCESS, NY 11042
(516) 358-1808
(646) 754-9854
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
019503
NY
103T00000X
Psychologist
50019503
NY
104100000X
Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1312677
—
MA
01
—
M18708
BLUE CROSS
MA
Enumeration date
08/29/2007
Last updated
04/07/2016
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