Provider Demographics
NPI:1790436368
Name:GOLDBERG, JAMES MCINTYRE (LCSWA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MCINTYRE
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 E LAVENDER AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4532
Mailing Address - Country:US
Mailing Address - Phone:919-450-8417
Mailing Address - Fax:
Practice Address - Street 1:117 HIDDEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-8949
Practice Address - Country:US
Practice Address - Phone:844-345-2256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0146341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical