Provider Demographics
NPI:1447421029
Name:GOEREN, WILLIAM ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ANTHONY
Last Name:GOEREN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 W 47TH ST APT 1E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-2369
Mailing Address - Country:US
Mailing Address - Phone:212-397-9061
Mailing Address - Fax:
Practice Address - Street 1:330 W 38TH ST STE 1410
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-8437
Practice Address - Country:US
Practice Address - Phone:212-397-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR039991-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN255S1OtherMEDICARE