Provider Demographics
NPI:1881191336
Name:GOLDMAN, SHANA R (LMSW)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:R
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 7TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3410
Mailing Address - Country:US
Mailing Address - Phone:518-270-2848
Mailing Address - Fax:
Practice Address - Street 1:1600 7TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3410
Practice Address - Country:US
Practice Address - Phone:518-270-2848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100480-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health