Provider Demographics
NPI:1821244062
Name:GOLDBERG, DELIA W (LMHC)
Entity Type:Individual
Prefix:MS
First Name:DELIA
Middle Name:W
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:DELIA
Other - Middle Name:
Other - Last Name:ISRAEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:64 JEFFERSON ST.
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701
Mailing Address - Country:US
Mailing Address - Phone:845-791-8800
Mailing Address - Fax:845-791-7051
Practice Address - Street 1:64 JEFFERSON STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12711
Practice Address - Country:US
Practice Address - Phone:845-791-8800
Practice Address - Fax:845-791-7051
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
NY003266-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool