Provider Demographics
NPI:1477235836
Name:GOLDSON, ANDREA MARIA (LCSW-R)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIA
Last Name:GOLDSON
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LEMELLE
Other - Last Name:GOLDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:7171 161ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-4638
Mailing Address - Country:US
Mailing Address - Phone:516-732-3609
Mailing Address - Fax:
Practice Address - Street 1:7171 161ST ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-4638
Practice Address - Country:US
Practice Address - Phone:516-732-3609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NYR043050-1101YM0800X, 101YP2500X, 103K00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst