Provider Demographics
NPI:1891812020
Name:GOLDBERG, CHRISTINE LATKA (BA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:LATKA
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6957 ROCKDALE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2547
Mailing Address - Country:US
Mailing Address - Phone:313-565-7373
Mailing Address - Fax:
Practice Address - Street 1:6957 ROCKDALE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2547
Practice Address - Country:US
Practice Address - Phone:313-359-0736
Practice Address - Fax:313-359-0736
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802005602104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker