Provider Demographics
NPI:1316397904
Name:GOLDBERG, DANA (LCSW-R)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 HEMPSTEAD TPKE STE 105
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2147
Mailing Address - Country:US
Mailing Address - Phone:347-509-9040
Mailing Address - Fax:
Practice Address - Street 1:2545 HEMPSTEAD TPKE STE 105
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2147
Practice Address - Country:US
Practice Address - Phone:347-509-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092679104100000X
NY0869001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker