Provider Demographics
NPI:1528031879
Name:GOLDNER, ROBIN (MSW)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:
Last Name:GOLDNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 S HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-3513
Mailing Address - Country:US
Mailing Address - Phone:707-459-5673
Mailing Address - Fax:
Practice Address - Street 1:245 S HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-3513
Practice Address - Country:US
Practice Address - Phone:707-459-5673
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACSW153731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW153730Medicaid
CACSW153730Medicaid