Provider Demographics
NPI:1841383015
Name:GOLDBERG, JOAN B (PHD)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:B
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:505 ELMWOOD AVENUE
Mailing Address - Street 2:#5K
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230
Mailing Address - Country:US
Mailing Address - Phone:718-258-5439
Mailing Address - Fax:718-258-5439
Practice Address - Street 1:690 BROADWAY
Practice Address - Street 2:SUITE 1 1ST FLOOR
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:718-258-5439
Practice Address - Fax:718-258-5439
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY005322103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0029720OtherVALUE OPTIONS INSURANCE
NYP1252361OtherOXFORD INSURANCE
NY00532268OtherHIP INSURANCE
0029720OtherGHI INSURANCE