Provider Demographics
NPI:1881655603
Name:GOLDBLUM, SHARON (LCSW)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:GOLDBLUM
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 1:25 ARBUTUS RD
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1126
Mailing Address - Country:US
Mailing Address - Phone:631-754-3860
Mailing Address - Fax:
Practice Address - Street 1:185 FROEHLICH FARM BLVD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2931
Practice Address - Country:US
Practice Address - Phone:516-921-8811
Practice Address - Fax:516-921-6313
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR022674-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical