Provider Demographics
NPI:1518608116
Name:GOLDBERG, WENDY ANNE
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANNE
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 N COUNTRY CLUB DR APT 403
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1771
Mailing Address - Country:US
Mailing Address - Phone:954-376-2149
Mailing Address - Fax:
Practice Address - Street 1:3401 N COUNTRY CLUB DR APT 403
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1771
Practice Address - Country:US
Practice Address - Phone:954-376-2149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical