Provider Demographics
NPI:1710315320
Name:GOLDSBORO, ADRIENNE (CSW)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:GOLDSBORO
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-2235
Mailing Address - Country:US
Mailing Address - Phone:856-935-6677
Mailing Address - Fax:856-935-0457
Practice Address - Street 1:470 IRVING AVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-2235
Practice Address - Country:US
Practice Address - Phone:856-935-6677
Practice Address - Fax:856-935-0457
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW01266100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker