Provider Demographics
NPI:1225324858
Name:GOLDSBOROUGH, THERESA GAIL (MSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:GAIL
Last Name:GOLDSBOROUGH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MOHAWK RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-5026
Mailing Address - Country:US
Mailing Address - Phone:914-779-5180
Mailing Address - Fax:
Practice Address - Street 1:72 MOHAWK RD
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-5026
Practice Address - Country:US
Practice Address - Phone:914-779-5180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR037893-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical