Provider Demographics
NPI:1730287830
Name:GOLDSHEID-MARTIN, AMY (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GOLDSHEID-MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:GOLDSHEID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:50 SAGAMORE ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2219
Mailing Address - Country:US
Mailing Address - Phone:516-353-5277
Mailing Address - Fax:801-642-5979
Practice Address - Street 1:50 SAGAMORE ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-2219
Practice Address - Country:US
Practice Address - Phone:516-353-5277
Practice Address - Fax:801-642-5979
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081038-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300118086Medicare PIN