Provider Demographics
NPI:1467531269
Name:GOLDBERG, LESLIE G (LICSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:G
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ROSE COURT WAY
Mailing Address - Street 2:
Mailing Address - City:EAST WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02032-1184
Mailing Address - Country:US
Mailing Address - Phone:508-660-6620
Mailing Address - Fax:508-660-6635
Practice Address - Street 1:1030 TURNPIKE ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2827
Practice Address - Country:US
Practice Address - Phone:781-828-8666
Practice Address - Fax:781-575-1795
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA862301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical