Provider Demographics
NPI:1336505270
Name:GOLDMAN, JAMIE HELENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:HELENE
Last Name:GOLDMAN
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 1:1349 ALCAZAR AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-6616
Mailing Address - Country:US
Mailing Address - Phone:561-289-8790
Mailing Address - Fax:
Practice Address - Street 1:12590 WHITEHALL DR
Practice Address - Street 2:SUITE 3
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4680
Practice Address - Country:US
Practice Address - Phone:239-939-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL133661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical