Provider Demographics
NPI:1013024470
Name:GOLDBERG, ANDREA B (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:B
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 BELLEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3652
Mailing Address - Country:US
Mailing Address - Phone:973-748-0045
Mailing Address - Fax:973-718-2902
Practice Address - Street 1:324 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3652
Practice Address - Country:US
Practice Address - Phone:973-748-0045
Practice Address - Fax:973-718-2902
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC050827001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJGO081001Medicare UPIN