Provider Demographics
NPI:1871631077
Name:GOLDBERG, JOYCE (LCSW)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 DIANE PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3007
Mailing Address - Country:US
Mailing Address - Phone:718-869-8400
Mailing Address - Fax:718-869-8405
Practice Address - Street 1:619 DIANE PL
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3007
Practice Address - Country:US
Practice Address - Phone:718-869-8400
Practice Address - Fax:718-869-8400
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO31736-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health