Provider Demographics
NPI:1902362643
Name:GOLDSTEIN, LORI JILL (LMSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JILL
Last Name:GOLDSTEIN
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 1:10 JUNIPER AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3026
Mailing Address - Country:US
Mailing Address - Phone:516-317-6182
Mailing Address - Fax:
Practice Address - Street 1:10 JUNIPER AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3026
Practice Address - Country:US
Practice Address - Phone:516-317-6182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053091104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker