Provider Demographics
NPI:1295948388
Name:GOLDBERG, ADRIENNE L (MSW)
Entity type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:L
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:ADRIENNE
Other - Middle Name:L
Other - Last Name:YATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1027 E 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-3036
Mailing Address - Country:US
Mailing Address - Phone:509-939-0800
Mailing Address - Fax:509-747-7984
Practice Address - Street 1:1027 E 39TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-3036
Practice Address - Country:US
Practice Address - Phone:509-939-0800
Practice Address - Fax:509-747-7984
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00006915104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker