Healthcare Provider Details

I. General information

NPI: 1174868137
Provider Name (Legal Business Name): LEAH ANNE GOLDSMITH MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2484 SHATTUCK AVE SUITE 210
BERKELEY CA
94704-2076
US

IV. Provider business mailing address

2484 SHATTUCK AVE SUITE 210
BERKELEY CA
94704-2076
US

V. Phone/Fax

Practice location:
  • Phone: 510-704-7475
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberACSW 34539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: