| Doctor Name: | DR. FREDERIC GOLDEN |
| NPI Number: | 1770613218 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 00101 |
| Business Practice Address: | 400 S Main Wood River, IL - 62095 |
| Business Phone Number: | 6182512175 |
| Business Fax Number: | 6182516294 |
| Mailing Address: | Box 349, 400 S Main WOOD RIVER |
| State: | IL |
| Postal Code: | 62095 |
| Phone Number: | 6182512175 |
| Fax Number: | 6182516294 |
| NPI Enumeration Date: | 03/06/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 00101 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |