Provider Demographics
NPI:1619336724
Name:GOLDBERG, TINA ALISON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:ALISON
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 1:5211 LINCOLNSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-5429
Mailing Address - Country:US
Mailing Address - Phone:469-766-0369
Mailing Address - Fax:
Practice Address - Street 1:5211 LINCOLNSHIRE CT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-5429
Practice Address - Country:US
Practice Address - Phone:469-766-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical