Provider Demographics
NPI:1255514857
Name:GOOLD, SARA ELLEN
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:ELLEN
Last Name:GOOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 WELLSFORD DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:CT
Mailing Address - Zip Code:06756-1817
Mailing Address - Country:US
Mailing Address - Phone:203-247-9305
Mailing Address - Fax:
Practice Address - Street 1:275 MADISON AVE STE 629
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1155
Practice Address - Country:US
Practice Address - Phone:203-247-9305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102L00000X
NY000781103TP0814X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN615LIOtherBLUE CROSS BLUE SHIELD