Provider Demographics
NPI:1366658262
Name:GOLDSMITH, ELLEN R (MA, MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:R
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:MA, MSW, LCSW
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Mailing Address - Street 1:6615 E PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 190
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4211
Mailing Address - Country:US
Mailing Address - Phone:562-708-6778
Mailing Address - Fax:562-431-1852
Practice Address - Street 1:6615 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE 190
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4211
Practice Address - Country:US
Practice Address - Phone:562-708-6778
Practice Address - Fax:562-431-1852
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA146761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14676OtherLCSW