Provider Demographics
NPI:1134909500
Name:GOLDMAN, YEHUDO ARYEH (LSW)
Entity type:Individual
Prefix:
First Name:YEHUDO
Middle Name:ARYEH
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:LIAM
Other - Middle Name:
Other - Last Name:GOLDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:L4 PINE TREE BLVD
Mailing Address - Street 2:APT 4D
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857
Mailing Address - Country:US
Mailing Address - Phone:732-890-9505
Mailing Address - Fax:
Practice Address - Street 1:L4 PINE TREE BLVD
Practice Address - Street 2:APT 4D
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857
Practice Address - Country:US
Practice Address - Phone:732-890-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06856800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker