Provider Demographics
NPI:1295804383
Name:GOLDNER, ROSLYN MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ROSLYN
Middle Name:MARIE
Last Name:GOLDNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:M
Other - Last Name:BLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 RIVERS DR.
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020
Mailing Address - Country:US
Mailing Address - Phone:516-487-8383
Mailing Address - Fax:516-773-3606
Practice Address - Street 1:25 RIVERS DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11020
Practice Address - Country:US
Practice Address - Phone:516-487-8383
Practice Address - Fax:516-773-3606
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR00186101103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
108174OtherMHN
0023660OtherGHI
0023660OtherGHI
108174OtherMHN