MEDICARE: DANIEL GOLDMAN, LCSW, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	7545-123	WI

General Provider Information

NPI Number	:	1477063212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL GOLDMAN, LCSW, LLC

Provider Business Mailing Address
First Line	:	1906 MONROE ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53711-2027
Country	:	US
Telephone Number	:	608-886-4839
Fax Number	:

Provider Business Practice Location Address
First Line	:	1906 MONROE ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53711-2027
Country	:	US
Telephone Number	:	608-886-4839
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL GOLDMAN
Credential	:	LCSW
Telephone Number	:	608-886-4839

Provider Enumeration Date	:	10/06/2017
Last Update Date	:	10/09/2017

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