Provider Demographics
NPI:1205022027
Name:SANDRA B GOLDHABER LCSW INC
Entity Type:Organization
Organization Name:SANDRA B GOLDHABER LCSW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOLDHABER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-421-6562
Mailing Address - Street 1:710 KIPLING ST
Mailing Address - Street 2:306
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-8002
Mailing Address - Country:US
Mailing Address - Phone:303-421-6562
Mailing Address - Fax:303-232-1473
Practice Address - Street 1:710 KIPLING ST
Practice Address - Street 2:306
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-8002
Practice Address - Country:US
Practice Address - Phone:303-421-6562
Practice Address - Fax:303-232-1473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-16
Last Update Date:2007-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9850611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty