Provider Demographics
NPI:1265542724
Name:TAPPER-GOLDMAN, RONNA (MSW)
Entity type:Individual
Prefix:MS
First Name:RONNA
Middle Name:
Last Name:TAPPER-GOLDMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 590444
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-0004
Mailing Address - Country:US
Mailing Address - Phone:617-244-3961
Mailing Address - Fax:617-244-3961
Practice Address - Street 1:53 LANGLEY RD
Practice Address - Street 2:SUITE 350
Practice Address - City:NEWTON CENTER
Practice Address - State:MA
Practice Address - Zip Code:02459-1913
Practice Address - Country:US
Practice Address - Phone:617-244-3961
Practice Address - Fax:617-244-3961
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1030001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MATA-P23920Medicare ID - Type Unspecified