Provider Demographics
NPI:1073659892
Name:GOLDMAN, JENNIFER C (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:C
Last Name:GOLDMAN
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 1:2554 TOWNHOUSE CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-2334
Mailing Address - Country:US
Mailing Address - Phone:917-327-4594
Mailing Address - Fax:914-376-9859
Practice Address - Street 1:2554 TOWNHOUSE CIR
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-2334
Practice Address - Country:US
Practice Address - Phone:917-327-4594
Practice Address - Fax:914-376-9859
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070325-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical