Provider Demographics
NPI:1497816771
Name:GOLDSTEIN, NANCY R (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:R
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 DEERING ST
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3909
Mailing Address - Country:US
Mailing Address - Phone:631-941-4704
Mailing Address - Fax:
Practice Address - Street 1:12 DEERING ST
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3909
Practice Address - Country:US
Practice Address - Phone:631-941-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-031744-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR-031744-1OtherSOCIAL WORK LICENSE
NYR-031744-1OtherSOCIAL WORK LICENSE