Provider Demographics
NPI:1558130591
Name:GOLDSMITH, ROSALYN (LAC)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 MORRIS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1025
Mailing Address - Country:US
Mailing Address - Phone:908-415-4149
Mailing Address - Fax:
Practice Address - Street 1:640 BLUEBERRY HL
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8758
Practice Address - Country:US
Practice Address - Phone:908-415-4149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00712900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health