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NPI Code Detail

MEDICARE: KASEY GOLDSTEIN LCSW

MEDICARE: KASEY 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
11041C0700XClinical Social Worker7305070-3501UT

General Provider Information

NPI Number : 1639604051
Entity Type Code : Individual
Provider Name (Legal Business Name) : KASEY GOLDSTEIN LCSW
Provider Business Mailing Address
First Line : 880 HERITAGE PARK BLVD STE 130
Second Line :
City : LAYTON
State : UT
Zip : 84041-5674
Country : US
Telephone Number : 801-335-4114
Fax Number :
Provider Business Practice Location Address
First Line : 880 HERITAGE PARK BLVD STE 130
Second Line :
City : LAYTON
State : UT
Zip : 84041-5674
Country : US
Telephone Number : 801-335-4114
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2017
Last Update Date : 07/06/2019

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