Provider Demographics
NPI:1497386080
Name:GOLDWASSER, ELLEN MARGARET (LCSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARGARET
Last Name:GOLDWASSER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 F ST UNIT 301
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-1676
Mailing Address - Country:US
Mailing Address - Phone:314-699-4216
Mailing Address - Fax:949-404-6103
Practice Address - Street 1:2200 N HIGHWAY 67 # 125
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-9997
Practice Address - Country:US
Practice Address - Phone:314-616-6211
Practice Address - Fax:949-404-6103
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150121731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical