Provider Demographics
NPI:1073271672
Name:GOLD, MARLENE DONNA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:DONNA
Last Name:GOLD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4809
Mailing Address - Country:US
Mailing Address - Phone:917-620-0556
Mailing Address - Fax:
Practice Address - Street 1:1517 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4809
Practice Address - Country:US
Practice Address - Phone:917-620-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001482101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty