Provider Demographics
NPI:1013009927
Name:GOLDSMITH, ELLEN LOIS (MSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:LOIS
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KING ST STE 203
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3243
Mailing Address - Country:US
Mailing Address - Phone:413-586-4065
Mailing Address - Fax:
Practice Address - Street 1:100 KING ST STE 203
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3243
Practice Address - Country:US
Practice Address - Phone:413-586-4065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10187471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP05728OtherBC/BS