Provider Demographics
NPI:1609047232
Name:GOFFMAN, ANITA B (LCSW)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:B
Last Name:GOFFMAN
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 1:200 W 70TH ST
Mailing Address - Street 2:# 9-H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4323
Mailing Address - Country:US
Mailing Address - Phone:212-769-8885
Mailing Address - Fax:
Practice Address - Street 1:200 W 70TH ST
Practice Address - Street 2:# 9-H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4323
Practice Address - Country:US
Practice Address - Phone:212-769-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR028118-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical