Provider Demographics
NPI:1770728503
Name:GOLDBERG, LOUISE (LMT)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 NW 54TH TER
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-1518
Mailing Address - Country:US
Mailing Address - Phone:954-977-5035
Mailing Address - Fax:
Practice Address - Street 1:827 SE 9TH ST
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-5633
Practice Address - Country:US
Practice Address - Phone:954-579-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA5309174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist