Provider Demographics
NPI:1780257931
Name:GOLDBERG, EMILY SAMANTHA (MS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:SAMANTHA
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:SAMANTHA
Other - Last Name:BLOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:96 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3928
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5115 NEW PEACHTREE RD STE 202
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-3326
Practice Address - Country:US
Practice Address - Phone:404-727-1139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS