Provider Demographics
NPI:1053728584
Name:GOLDBERG, KRISTIN KERI
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KERI
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:KERI
Other - Last Name:ABBATE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, PSYD
Mailing Address - Street 1:4848 E CACTUS RD
Mailing Address - Street 2:SUITE 940
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4163
Mailing Address - Country:US
Mailing Address - Phone:480-443-0050
Mailing Address - Fax:
Practice Address - Street 1:4848 E CACTUS RD
Practice Address - Street 2:SUITE 940
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4163
Practice Address - Country:US
Practice Address - Phone:480-443-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4320103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical