Provider Demographics
NPI:1770539496
Name:GOLDSCHMIDT, DOUGLAS DANIEL (LCSWR)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:DANIEL
Last Name:GOLDSCHMIDT
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SUMMERHAVEN DR N
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-3127
Mailing Address - Country:US
Mailing Address - Phone:315-414-8896
Mailing Address - Fax:
Practice Address - Street 1:305 SUMMERHAVEN DR N
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-3127
Practice Address - Country:US
Practice Address - Phone:315-414-8896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73 0760161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical