Provider Demographics
NPI:1770868309
Name:ELLEN R GOLDSMITH, LCSW, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ELLEN R GOLDSMITH, LCSW, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:562-708-6778
Mailing Address - Street 1:6615 E PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 190
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4211
Mailing Address - Country:US
Mailing Address - Phone:562-708-6778
Mailing Address - Fax:562-431-1852
Practice Address - Street 1:6615 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE 190
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4211
Practice Address - Country:US
Practice Address - Phone:562-708-6778
Practice Address - Fax:562-431-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 146761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty