Provider Demographics
NPI:1184518664
Name:GOLD COAST PSYCHOLOGICAL SERVICES, PC
Entity type:Organization
Organization Name:GOLD COAST PSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:201-477-8193
Mailing Address - Street 1:220 9TH ST STE 2041
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4288
Mailing Address - Country:US
Mailing Address - Phone:201-733-4277
Mailing Address - Fax:
Practice Address - Street 1:220 9TH ST STE 2041
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4288
Practice Address - Country:US
Practice Address - Phone:201-733-4277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-07
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty