Healthcare Provider Details

I. General information

NPI: 1922928936
Provider Name (Legal Business Name): JODIE LYNN GOLDBERG LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HIGH RIDGE RD
STAMFORD CT
06905-1223
US

IV. Provider business mailing address

6 N MIDLAND AVE UNIT 301
NYACK NY
10960-2576
US

V. Phone/Fax

Practice location:
  • Phone: 203-208-6072
  • Fax: 203-951-6402
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: