Provider Demographics
NPI:1043789480
Name:GOLDMAN, REGINA (LCSW-R)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16423 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3555
Mailing Address - Country:US
Mailing Address - Phone:516-448-3186
Mailing Address - Fax:
Practice Address - Street 1:1554 NORTHERN BLVD FL 1
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3006
Practice Address - Country:US
Practice Address - Phone:516-472-5867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0524191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical