Provider Demographics
NPI:1992824585
Name:GOLDMAN, AMY S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:S
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 1:760 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1235
Mailing Address - Country:US
Mailing Address - Phone:415-836-1700
Mailing Address - Fax:415-836-1737
Practice Address - Street 1:760 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1235
Practice Address - Country:US
Practice Address - Phone:415-836-1700
Practice Address - Fax:415-836-1737
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW244171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1198OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
1198OtherSFGH INTERNAL USE ONLY