MEDICARE: ROSLYN GOLDSTEIN LCSW

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	LCS11032	CA

General Provider Information

NPI Number	:	1609949080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSLYN GOLDSTEIN LCSW

Provider Business Mailing Address
First Line	:	3715 6TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4316
Country	:	US
Telephone Number	:	619-291-0473
Fax Number	:	619-220-6015

Provider Business Practice Location Address
First Line	:	3715 6TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4316
Country	:	US
Telephone Number	:	619-291-0473
Fax Number	:	619-220-6015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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