Provider Demographics
NPI:1265664106
Name:GOLBURT, ALLA (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:GOLBURT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BREARLY CRES
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3553
Mailing Address - Country:US
Mailing Address - Phone:201-791-3256
Mailing Address - Fax:
Practice Address - Street 1:33-11 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-4634
Practice Address - Country:US
Practice Address - Phone:201-794-9797
Practice Address - Fax:646-619-4299
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053668001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical