Provider Demographics
NPI:1659779049
Name:GOLDMAN SEGAL, CORI (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:CORI
Middle Name:
Last Name:GOLDMAN SEGAL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DAWN CIR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3370
Mailing Address - Country:US
Mailing Address - Phone:617-877-1572
Mailing Address - Fax:
Practice Address - Street 1:60 GRANITE ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2915
Practice Address - Country:US
Practice Address - Phone:781-477-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10290141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical