Provider Demographics
NPI:1790940799
Name:GOLDENBERG, MARIA LANA (AUD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LANA
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 N SHADELAND AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2029
Mailing Address - Country:US
Mailing Address - Phone:317-570-7353
Mailing Address - Fax:
Practice Address - Street 1:11733 FOREST PARK LN
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-7223
Practice Address - Country:US
Practice Address - Phone:314-494-4910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-20
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007014907231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist