Provider Demographics
NPI:1356532998
Name:WEINER GOLDSMITH DEVELOPMENT ASSOCIATES
Entity type:Organization
Organization Name:WEINER GOLDSMITH DEVELOPMENT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:732-977-9104
Mailing Address - Street 1:134 W END AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1816
Mailing Address - Country:US
Mailing Address - Phone:732-977-9104
Mailing Address - Fax:
Practice Address - Street 1:134 W END AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1816
Practice Address - Country:US
Practice Address - Phone:732-977-9104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052259001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ092642Medicare PIN