Provider Demographics
NPI:1154676484
Name:GOLANI, ROBERTA S (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:S
Last Name:GOLANI
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MRS
Other - First Name:ROBERTA
Other - Middle Name:S
Other - Last Name:FELDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:3015 SEAFARER CV
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-8522
Mailing Address - Country:US
Mailing Address - Phone:260-471-2300
Mailing Address - Fax:
Practice Address - Street 1:3842 NEW VISION DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1708
Practice Address - Country:US
Practice Address - Phone:260-417-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006485A1041C0700X, 1041C0700X
MI68010847241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical