Provider Demographics
NPI:1184696304
Name:GOLDEN, OWEN JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:OWEN
Middle Name:
Last Name:GOLDEN
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 N. 16TH ST. SUITE A-120
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020
Mailing Address - Country:US
Mailing Address - Phone:602-997-6635
Mailing Address - Fax:602-997-6642
Practice Address - Street 1:7330 N. 16TH ST. SUITE A-120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020
Practice Address - Country:US
Practice Address - Phone:602-997-6635
Practice Address - Fax:602-997-6642
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW03941041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
27882Medicare PIN
AZ27882Medicare UPIN