Provider Demographics
NPI:1619397270
Name:GOLDVARG, ESTER
Entity Type:Individual
Prefix:
First Name:ESTER
Middle Name:
Last Name:GOLDVARG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 E 67TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6007
Mailing Address - Country:US
Mailing Address - Phone:917-216-9638
Mailing Address - Fax:718-621-0002
Practice Address - Street 1:5322 AVENUE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3910
Practice Address - Country:US
Practice Address - Phone:917-216-9638
Practice Address - Fax:718-621-0002
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020530-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical