Provider Demographics
NPI:1811443013
Name:MIRIAM GOLD LCSW, PLLC
Entity type:Organization
Organization Name:MIRIAM GOLD LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:919-638-3946
Mailing Address - Street 1:743 WEATHERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3224
Mailing Address - Country:US
Mailing Address - Phone:919-673-6298
Mailing Address - Fax:
Practice Address - Street 1:4913 PROFESSIONAL CT
Practice Address - Street 2:SUITE 5
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4913
Practice Address - Country:US
Practice Address - Phone:919-638-3946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty