MEDICARE: MRS. LIZA GOLD

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	0870705	NY

General Provider Information

NPI Number	:	1710372669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LIZA GOLD

Provider Business Mailing Address
First Line	:	51 E 25TH ST
Second Line	:	LOWER LEVEL
City	:	NEW YORK
State	:	NY
Zip	:	10010-2945
Country	:	US
Telephone Number	:	610-757-5550
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 LEXINGTON AVE FL 4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-3912
Country	:	US
Telephone Number	:	610-757-5550
Fax Number	:

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

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	11/02/2018

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Directions to “ MRS. LIZA GOLD ” Practice Location

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