Provider Demographics
NPI:1023773116
Name:GOLDBERG, ALYSSA JOHANNA (LCSW)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JOHANNA
Last Name:GOLDBERG
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 1:100 HOBOKEN AVE APT 327
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-1158
Mailing Address - Country:US
Mailing Address - Phone:443-690-6613
Mailing Address - Fax:
Practice Address - Street 1:100 HOBOKEN AVE APT 327
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-1158
Practice Address - Country:US
Practice Address - Phone:443-690-6613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC063627001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty