Provider Demographics
NPI:1659500676
Name:GOLDSTEIN, MIREL TZIVIA (MS, MA)
Entity Type:Individual
Prefix:
First Name:MIREL
Middle Name:TZIVIA
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 KATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1230
Mailing Address - Country:US
Mailing Address - Phone:303-204-7039
Mailing Address - Fax:
Practice Address - Street 1:43 KATHERINE AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1230
Practice Address - Country:US
Practice Address - Phone:303-204-7039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-12
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00391500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9749345OtherAETNA