Provider Demographics
NPI:1710465802
Name:GOLDBERG, ELAINE BETH (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:BETH
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:GOLDBERG SHEEHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:143 NEEDHAM ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-7097
Mailing Address - Country:US
Mailing Address - Phone:781-310-2200
Mailing Address - Fax:
Practice Address - Street 1:143 NEEDHAM ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-7097
Practice Address - Country:US
Practice Address - Phone:781-310-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10260811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical