MEDICARE: DR. DALE ILSLEY GOLDBERG LCSW, PH.D.

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	CW014038	PA

General Provider Information

NPI Number	:	1902886450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE ILSLEY GOLDBERG LCSW, PH.D.

Provider Business Mailing Address
First Line	:	2053 SPRING VALLEY RD
Second Line	:
City	:	LANSDALE
State	:	PA
Zip	:	19446-5110
Country	:	US
Telephone Number	:	610-584-6179
Fax Number	:

Provider Business Practice Location Address
First Line	:	2053 SPRING VALLEY RD
Second Line	:
City	:	LANSDALE
State	:	PA
Zip	:	19446-5110
Country	:	US
Telephone Number	:	610-584-6179
Fax Number	:

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	07/08/2007

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