Provider Demographics
NPI:1447341615
Name:CLINICAL ASSOCIATES OF TIDEWATER
Entity type:Organization
Organization Name:CLINICAL ASSOCIATES OF TIDEWATER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-877-7700
Mailing Address - Street 1:12695 MCMANUS BLVD BLDG 8
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4442
Mailing Address - Country:US
Mailing Address - Phone:757-877-7700
Mailing Address - Fax:757-872-7211
Practice Address - Street 1:12695 MCMANUS BLVD BLDG 8
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4442
Practice Address - Country:US
Practice Address - Phone:757-877-7700
Practice Address - Fax:757-872-7211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty