Provider Demographics
NPI:1639140932
Name:GOLD, EDWARD SAMUEL (LMSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:SAMUEL
Last Name:GOLD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:CHAIM
Other - Middle Name:
Other - Last Name:GOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:713 CROWN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5451
Mailing Address - Country:US
Mailing Address - Phone:718-735-1179
Mailing Address - Fax:
Practice Address - Street 1:348 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5004
Practice Address - Country:US
Practice Address - Phone:718-788-2461
Practice Address - Fax:718-788-8274
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062878101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health