Provider Demographics
NPI:1437756889
Name:GOLDSMITH, DUSTIE L (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:DUSTIE
Middle Name:L
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4755 KINGSWAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1549
Mailing Address - Country:US
Mailing Address - Phone:317-259-7013
Mailing Address - Fax:
Practice Address - Street 1:4755 KINGSWAY DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1549
Practice Address - Country:US
Practice Address - Phone:317-259-7013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33008859A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker