Provider Demographics
NPI:1649006412
Name:GOLDBERG, AMY LORENE (BSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LORENE
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-0028
Mailing Address - Country:US
Mailing Address - Phone:301-706-7110
Mailing Address - Fax:
Practice Address - Street 1:6 HAMMOND ST # 28
Practice Address - Street 2:
Practice Address - City:MATTAPOISETT
Practice Address - State:MA
Practice Address - Zip Code:02739-2602
Practice Address - Country:US
Practice Address - Phone:301-706-7110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health