Provider Demographics
NPI:1255997714
Name:GOLDBERG, GARY JEFFREY (LCSW)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:JEFFREY
Last Name:GOLDBERG
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 1:910 SOCIETY HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2415
Mailing Address - Country:US
Mailing Address - Phone:609-670-7841
Mailing Address - Fax:
Practice Address - Street 1:900 ROUTE 168 STE D1
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-3207
Practice Address - Country:US
Practice Address - Phone:856-228-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001867001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical