Provider Demographics
NPI:1649458266
Name:GOLDENBERG, RAYA (LMSW ACSW)
Entity type:Individual
Prefix:MS
First Name:RAYA
Middle Name:
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:LMSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E BIG BEAVER RD
Mailing Address - Street 2:101
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1426
Mailing Address - Country:US
Mailing Address - Phone:248-740-9360
Mailing Address - Fax:248-740-9374
Practice Address - Street 1:625 E BIG BEAVER RD
Practice Address - Street 2:101
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1426
Practice Address - Country:US
Practice Address - Phone:248-740-9360
Practice Address - Fax:248-740-9374
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010110471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical