Provider Demographics
NPI:1508036898
Name:GOLDBERG, ANNE FREED (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:FREED
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:FREED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:508 E SOUTH TEMPLE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1013
Mailing Address - Country:US
Mailing Address - Phone:801-865-1390
Mailing Address - Fax:801-355-1723
Practice Address - Street 1:508 E SOUTH TEMPLE
Practice Address - Street 2:SUITE 206
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1013
Practice Address - Country:US
Practice Address - Phone:801-865-1390
Practice Address - Fax:801-355-1723
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT474112335011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical