Provider Demographics
NPI:1760699383
Name:GOLDSTEIN, SHEPPARD M (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SHEPPARD
Middle Name:M
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 CORAL RIDGE DR
Mailing Address - Street 2:SUITE 288
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5433
Mailing Address - Country:US
Mailing Address - Phone:954-345-3898
Mailing Address - Fax:954-281-8827
Practice Address - Street 1:1440 CORAL RIDGE DR
Practice Address - Street 2:SUITE 288
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-5433
Practice Address - Country:US
Practice Address - Phone:954-345-3898
Practice Address - Fax:954-281-8827
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW58491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ0423CMedicare ID - Type UnspecifiedLCSW