Provider Demographics
NPI:1902246341
Name:GOUDSMIT PSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:GOUDSMIT PSYCHOLOGY, PLLC
Other - Org Name:NORA GOUDSMIT, PH.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUDSMIT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-852-3171
Mailing Address - Street 1:640 S SAN VICENTE BLVD STE 476
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4661
Mailing Address - Country:US
Mailing Address - Phone:323-852-3171
Mailing Address - Fax:
Practice Address - Street 1:640 S SAN VICENTE BLVD STE 476
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4661
Practice Address - Country:US
Practice Address - Phone:323-852-3171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-30
Last Update Date:2018-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019531103G00000X, 103TC0700X
CA28867103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty