Provider Demographics
NPI:1063449171
Name:GOLDENSON, VIVIEN M (LSW)
Entity Type:Individual
Prefix:MS
First Name:VIVIEN
Middle Name:M
Last Name:GOLDENSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 VINE CT
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-1219
Mailing Address - Country:US
Mailing Address - Phone:724-946-2289
Mailing Address - Fax:
Practice Address - Street 1:2540 NEW BUTLER RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-3225
Practice Address - Country:US
Practice Address - Phone:724-657-3303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW002046E104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000203196OtherUNISON
PA910877OtherHIGHMARK
PA7757310OtherAETNA BEHAVIORAL HEALTH
PA112692OtherVALUE OPTIONSTRICARE
PA112692OtherVALUE OPTIONSTRICARE