Provider Demographics
NPI:1588654677
Name:GOLDSTEIN, KAREN (MSW LCSW DCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MSW LCSW DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 HEWLETT AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5325
Mailing Address - Country:US
Mailing Address - Phone:516-378-6435
Mailing Address - Fax:516-378-4978
Practice Address - Street 1:2924 HEWLETT AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-5325
Practice Address - Country:US
Practice Address - Phone:516-378-6435
Practice Address - Fax:516-378-4978
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04067511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1479469Medicaid
N56072Medicare UPIN
NY1479469Medicaid