Provider Demographics
NPI:1942212063
Name:GOLDWYN-LIFF, GLORIA ROSLYN (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:ROSLYN
Last Name:GOLDWYN-LIFF
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 CAUSEWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2148
Mailing Address - Country:US
Mailing Address - Phone:617-248-1356
Mailing Address - Fax:617-248-1406
Practice Address - Street 1:251 CAUSEWAY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2148
Practice Address - Country:US
Practice Address - Phone:617-248-1082
Practice Address - Fax:617-248-1406
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1013981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA101398OtherLICSW