Provider Demographics
NPI:1700446382
Name:GOLDBERG, JACOB (MSW,LMSW,LAC,CCS)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MSW,LMSW,LAC,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 READ BLVD FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-3106
Mailing Address - Country:US
Mailing Address - Phone:504-513-4200
Mailing Address - Fax:
Practice Address - Street 1:5620 READ BLVD FL 5
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-3106
Practice Address - Country:US
Practice Address - Phone:504-513-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1460101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)