Provider Demographics
NPI:1578946786
Name:GOLDMAN, RETA (LCMHC, RPT)
Entity Type:Individual
Prefix:
First Name:RETA
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:LCMHC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 N ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2321
Mailing Address - Country:US
Mailing Address - Phone:540-809-3706
Mailing Address - Fax:
Practice Address - Street 1:25 LOWELL ST STE 208
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101
Practice Address - Country:US
Practice Address - Phone:540-809-3706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional