Provider Demographics
NPI:1598103707
Name:GOLUB, CHERYL A (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:GOLUB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 OLDE WOODS LN
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1743
Mailing Address - Country:US
Mailing Address - Phone:914-772-3123
Mailing Address - Fax:845-818-3705
Practice Address - Street 1:210 SUMMIT AVE
Practice Address - Street 2:SUITE A9
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1579
Practice Address - Country:US
Practice Address - Phone:914-772-3123
Practice Address - Fax:845-818-3705
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055455001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical