Provider Demographics
NPI:1093949083
Name:GOLDFARB, MICHAEL JOSEPH (LICSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:GOLDFARB
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 HENNEPIN AVE S
Mailing Address - Street 2:#B301
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2647
Mailing Address - Country:US
Mailing Address - Phone:612-825-3440
Mailing Address - Fax:612-827-2477
Practice Address - Street 1:3001 HENNEPIN AVE S
Practice Address - Street 2:#B301
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2647
Practice Address - Country:US
Practice Address - Phone:612-825-3440
Practice Address - Fax:612-827-2477
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN137051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical