Provider Demographics
NPI:1255897518
Name:GOLBORO, PETER (LCSW)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:GOLBORO
Suffix:
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 1:33 E BROWNING RD APT 2A
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1127
Mailing Address - Country:US
Mailing Address - Phone:610-787-9936
Mailing Address - Fax:
Practice Address - Street 1:1 MALL DR STE 925
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2110
Practice Address - Country:US
Practice Address - Phone:717-850-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059748001041C0700X
NJ44SL06262500104100000X
PASW133566104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker