Provider Demographics
NPI:1518055086
Name:GOLDBERG, DEB N (ICAADC, LPC, PMH)
Entity Type:Individual
Prefix:
First Name:DEB
Middle Name:N
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:ICAADC, LPC, PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 AZALEA ST
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2201
Mailing Address - Country:US
Mailing Address - Phone:305-906-1032
Mailing Address - Fax:305-906-6929
Practice Address - Street 1:92300 OVERSEAS HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2726
Practice Address - Country:US
Practice Address - Phone:305-906-1032
Practice Address - Fax:305-906-6929
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACAC 3835101YA0400X
PALPC 000024101YM0800X
FLPMH 1364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11702063OtherCAQH UNIVERSAL CREDENTIALING DATASOURCE