Healthcare Provider Details

I. General information

NPI: 1437861085
Provider Name (Legal Business Name): JEREMY GOLDSMITH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 CAMPUS DR
YREKA CA
96097-9538
US

IV. Provider business mailing address

114 W 7TH ST STE 900
AUSTIN TX
78701-3013
US

V. Phone/Fax

Practice location:
  • Phone: 530-841-4100
  • Fax:
Mailing address:
  • Phone: 512-838-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: