Provider Demographics
NPI:1659945285
Name:GOLDBERG, CARRIE MELISSA (ATR-BC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:MELISSA
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 MARTINE AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2398
Mailing Address - Country:US
Mailing Address - Phone:201-747-7147
Mailing Address - Fax:
Practice Address - Street 1:1153 MARTINE AVE
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-2398
Practice Address - Country:US
Practice Address - Phone:201-747-7147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty