Provider Demographics
NPI:1972673986
Name:BERNSTEIN-GOFF, SHELI (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:SHELI
Middle Name:
Last Name:BERNSTEIN-GOFF
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 1:207 FAIRMONT AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2710
Mailing Address - Country:US
Mailing Address - Phone:681-404-6869
Mailing Address - Fax:681-404-6871
Practice Address - Street 1:3135 16TH STREET
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-5247
Practice Address - Country:US
Practice Address - Phone:681-404-6869
Practice Address - Fax:681-404-6871
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009408011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical