Provider Demographics
NPI:1467859462
Name:GOLDBERG, AMY (LMT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 RANTOUL ST
Mailing Address - Street 2:#307
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3255
Mailing Address - Country:US
Mailing Address - Phone:978-471-0344
Mailing Address - Fax:
Practice Address - Street 1:111 CANAL ST
Practice Address - Street 2:SUITE A
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-4649
Practice Address - Country:US
Practice Address - Phone:978-744-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12130225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist