Healthcare Provider Details

I. General information

NPI: 1780715805
Provider Name (Legal Business Name): JOSHUA DAVID GOLDMAN MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 28TH ST STE 200B
BOULDER CO
80303-1756
US

IV. Provider business mailing address

1200 28TH ST STE 200B
BOULDER CO
80303-1756
US

V. Phone/Fax

Practice location:
  • Phone: 303-598-3974
  • Fax:
Mailing address:
  • Phone: 303-598-3974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1068
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: