Provider Demographics
NPI:1609880343
Name:GOLDBERG, LOUIE ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LOUIE
Middle Name:ANN
Last Name:GOLDBERG
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 1:2305C ASHLAND ST
Mailing Address - Street 2:# 305
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1407
Mailing Address - Country:US
Mailing Address - Phone:541-944-7331
Mailing Address - Fax:541-488-8025
Practice Address - Street 1:400 W HERSEY ST STE 3
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1839
Practice Address - Country:US
Practice Address - Phone:541-944-7331
Practice Address - Fax:541-488-8025
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL19521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical