Provider Demographics
NPI:1083875736
Name:GOLDSWER, JASON K (LCSW, LISW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:K
Last Name:GOLDSWER
Suffix:
Gender:M
Credentials:LCSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 W SOUTH BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5234
Mailing Address - Country:US
Mailing Address - Phone:419-873-8280
Mailing Address - Fax:419-873-8320
Practice Address - Street 1:1090 W SOUTH BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5234
Practice Address - Country:US
Practice Address - Phone:419-873-8280
Practice Address - Fax:419-873-8320
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070572104100000X
OHS1450317104100000X
NY082274-11041C0700X
OHI14508761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker