Provider Demographics
NPI:1396014957
Name:GOLDFARB, DAVID WARREN (RLCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WARREN
Last Name:GOLDFARB
Suffix:
Gender:M
Credentials:RLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-6110
Mailing Address - Country:US
Mailing Address - Phone:631-434-2561
Mailing Address - Fax:631-434-2319
Practice Address - Street 1:2 6TH AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-6110
Practice Address - Country:US
Practice Address - Phone:631-434-2561
Practice Address - Fax:631-434-2319
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0384771041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool