| Doctor Name: | MR. MICHAEL W GOLDBERG |
| NPI Number: | 1043340987 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.A. |
| License Number: | 308194 |
| Business Practice Address: | 113 Hawk Drive Dulce, NM - 87528 |
| Business Phone Number: | 5057592954 |
| Business Fax Number: | 5057591349 |
| Mailing Address: | 98 Bull Elk Pl, PAGOSA SPRINGS |
| State: | CO |
| Postal Code: | 811478511 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/07/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 308194 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |