Provider Demographics
NPI:1578220513
Name:GOLDSMITH, AYALA CHAVA (LMSW)
Entity Type:Individual
Prefix:
First Name:AYALA
Middle Name:CHAVA
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:AYALA
Other - Middle Name:CHAVA
Other - Last Name:GOLDSMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AYALA GOLDSMITH LMSW
Mailing Address - Street 1:2020 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223
Mailing Address - Country:US
Mailing Address - Phone:718-676-4280
Mailing Address - Fax:718-676-4299
Practice Address - Street 1:2020 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223
Practice Address - Country:US
Practice Address - Phone:718-676-4280
Practice Address - Fax:718-676-4299
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114955104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker