Provider Demographics
NPI:1649311432
Name:HARRISON GOLDMAN, TERRY (EDD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:
Last Name:HARRISON GOLDMAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 BIRD RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1602
Mailing Address - Country:US
Mailing Address - Phone:508-339-1628
Mailing Address - Fax:401-521-0035
Practice Address - Street 1:1600 ROCKLAND RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-651-4200
Practice Address - Fax:302-651-4543
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00805103TC0700X, 103G00000X
DEB1-0001121103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI00410415Medicare UPIN
RI241894Medicare UPIN
RI689024124Medicare ID - Type Unspecified