Provider Demographics
NPI:1154068336
Name:GOLDSMITH, MELISSA (LMSW, CCLS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:LMSW, CCLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1405
Mailing Address - Country:US
Mailing Address - Phone:917-572-3417
Mailing Address - Fax:
Practice Address - Street 1:245 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-2670
Practice Address - Country:US
Practice Address - Phone:917-572-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067163104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker