Provider Demographics
NPI:1356681266
Name:GOLDMANN, ELIZABETH TAMAR (LICSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TAMAR
Last Name:GOLDMANN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-1811
Mailing Address - Country:US
Mailing Address - Phone:617-571-7854
Mailing Address - Fax:781-862-9482
Practice Address - Street 1:79 NORTH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-1811
Practice Address - Country:US
Practice Address - Phone:617-571-7854
Practice Address - Fax:781-862-9482
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1147411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical