Provider Demographics
NPI:1336257401
Name:GOLDSMITH, JEANINE H (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:H
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2902
Mailing Address - Country:US
Mailing Address - Phone:631-833-1700
Mailing Address - Fax:
Practice Address - Street 1:2070 DEER PARK AVE
Practice Address - Street 2:STE D
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2134
Practice Address - Country:US
Practice Address - Phone:631-522-1888
Practice Address - Fax:631-522-1889
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0723091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical