| Doctor Name: | KENNETH GOLDBERG |
| NPI Number: | 1770992547 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 2258 |
| Business Practice Address: | 215 Highland Ave Suite C Haddon Township, NJ - 081082634 |
| Business Phone Number: | 8565474000 |
| Business Fax Number: | 8565471118 |
| Mailing Address: | Po Box 3702, CHERRY HILL |
| State: | NJ |
| Postal Code: | 080340569 |
| Phone Number: | 8565474000 |
| Fax Number: | |
| NPI Enumeration Date: | 08/06/2014 |
| NPI Last Update Date: | 08/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 2258 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |