Provider Demographics
NPI:1326719576
Name:GOLDSTOCK, LOREEN
Entity Type:Individual
Prefix:
First Name:LOREEN
Middle Name:
Last Name:GOLDSTOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41D EDGEWATER PARK
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-3509
Mailing Address - Country:US
Mailing Address - Phone:914-663-7201
Mailing Address - Fax:914-663-7203
Practice Address - Street 1:41D EDGEWATER PARK
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-3509
Practice Address - Country:US
Practice Address - Phone:914-663-7201
Practice Address - Fax:914-663-7203
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty