Provider Demographics
NPI:1508901760
Name:GOLDBERG, MARGARET E (LCSW, CSAC)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:E
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 WILI PA LOOP STE 7
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1271
Mailing Address - Country:US
Mailing Address - Phone:808-249-2121
Mailing Address - Fax:808-242-8920
Practice Address - Street 1:1787 WILI PA LOOP STE 7
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1271
Practice Address - Country:US
Practice Address - Phone:808-249-2121
Practice Address - Fax:808-242-8920
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-31511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI57631601Medicaid
HI57631601Medicaid