Provider Demographics
NPI:1669501938
Name:GOLDBERG, KAREN LAURIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LAURIE
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:135 W 75TH ST
Mailing Address - Street 2:APARTMENT 1R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-1835
Mailing Address - Country:US
Mailing Address - Phone:212-362-2569
Mailing Address - Fax:212-362-2569
Practice Address - Street 1:135 W 75TH ST
Practice Address - Street 2:APARTMENT 1R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-1835
Practice Address - Country:US
Practice Address - Phone:212-362-2569
Practice Address - Fax:212-362-2569
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0179591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS2255OtherOXFORD HEALTH PLAN ID NUM