Provider Demographics
NPI:1487660213
Name:KEITH GOLIN PHD LLC
Entity type:Organization
Organization Name:KEITH GOLIN PHD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-992-4639
Mailing Address - Street 1:18 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1432
Mailing Address - Country:US
Mailing Address - Phone:888-284-2034
Mailing Address - Fax:973-992-4639
Practice Address - Street 1:659 EAGLE ROCK AVE STE 4
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2138
Practice Address - Country:US
Practice Address - Phone:888-284-2034
Practice Address - Fax:973-992-4639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC0700X
NJ35S100409900103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0114065Medicaid
NY02330954Medicaid
NJ6102096OtherEVERCARE
NY02330954Medicaid
NJ102341Medicare ID - Type UnspecifiedGROUP
NJVH9 098899Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST
NJ0114065Medicaid