Provider Demographics
NPI:1851323422
Name:GOLDBERG, STEVEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 VICTORY BLVD
Mailing Address - Street 2:5K
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3502
Mailing Address - Country:US
Mailing Address - Phone:718-390-8992
Mailing Address - Fax:718-983-0348
Practice Address - Street 1:610 VICTORY BLVD
Practice Address - Street 2:5K
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3502
Practice Address - Country:US
Practice Address - Phone:718-390-8992
Practice Address - Fax:718-983-0348
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR043983-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN4B732Medicare ID - Type UnspecifiedLCSW