Provider Demographics
NPI:1649776055
Name:GOLDENBERG, JENNIFER L (LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 STRANGFORD CT
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5238
Mailing Address - Country:US
Mailing Address - Phone:516-749-7799
Mailing Address - Fax:
Practice Address - Street 1:24 STRANGFORD CT
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5238
Practice Address - Country:US
Practice Address - Phone:516-749-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001155106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist