Provider Demographics
NPI:1659663516
Name:GOLDIN, MARJORIE (LCSW)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:
Last Name:GOLDIN
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 1:74 DEFOREST RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4809
Mailing Address - Country:US
Mailing Address - Phone:631-499-8322
Mailing Address - Fax:
Practice Address - Street 1:50 SPENCE AVENUE
Practice Address - Street 2:TAMARAC ELEMENTARY SCHOOL
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1929
Practice Address - Country:US
Practice Address - Phone:631-244-5680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY54237601041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool