Provider Demographics
NPI:1376861625
Name:GOLDBERG, PATRICE MICHELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:MICHELLE
Last Name:GOLDBERG
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 1:120 POINT VIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2064
Mailing Address - Country:US
Mailing Address - Phone:973-694-7426
Mailing Address - Fax:
Practice Address - Street 1:616 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7525
Practice Address - Country:US
Practice Address - Phone:201-218-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC043814001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical