Provider Demographics
NPI:1982749784
Name:GOLDBERG, LORI BETH (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:BETH
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:BETH
Other - Last Name:SHAPIRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:10950 SCHUETZ ROAD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146
Mailing Address - Country:US
Mailing Address - Phone:314-812-9333
Mailing Address - Fax:
Practice Address - Street 1:10950 SCHUETZ ROAD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146
Practice Address - Country:US
Practice Address - Phone:314-812-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0008951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical