Provider Demographics
NPI:1881000974
Name:GOLDBERG, MEREDITH (LCSW)
Entity Type:Individual
Prefix:
First Name:MEREDITH
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 1:3758 S IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:ST FRANCIS
Mailing Address - State:WI
Mailing Address - Zip Code:53235-4163
Mailing Address - Country:US
Mailing Address - Phone:414-748-1218
Mailing Address - Fax:
Practice Address - Street 1:1037 W MCKINLEY AVE STE 366
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-2530
Practice Address - Country:US
Practice Address - Phone:414-501-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129101-121171M00000X
WI8561-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator