Provider Demographics
NPI:1891711149
Name:GOLDMAN, MONIQUE (LCSW)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:GOLDMAN
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 1:72 NORTH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5648
Mailing Address - Country:US
Mailing Address - Phone:203-798-0068
Mailing Address - Fax:203-798-8859
Practice Address - Street 1:72 NORTH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5648
Practice Address - Country:US
Practice Address - Phone:203-798-0068
Practice Address - Fax:203-798-8859
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0056381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical