Provider Demographics
NPI:1407867526
Name:GOLDSMITH, LOIS A
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:A
Last Name:GOLDSMITH
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 1:116 MONTGOMERY BLVD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11509-1414
Mailing Address - Country:US
Mailing Address - Phone:516-239-7256
Mailing Address - Fax:516-374-2261
Practice Address - Street 1:116 MONTGOMERY BLVD
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11509-1414
Practice Address - Country:US
Practice Address - Phone:516-239-7256
Practice Address - Fax:516-374-2261
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR01530811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R46892Medicare UPIN
N33761Medicare ID - Type Unspecified