Healthcare Provider Details

I. General information

NPI: 1780608737
Provider Name (Legal Business Name): ROBERTA SUSAN GOLDSTEIN ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST 11EM/VIST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

15761 SW 24TH ST
MIRAMAR FL
33027-4265
US

V. Phone/Fax

Practice location:
  • Phone: 305-324-4455
  • Fax: 305-575-3312
Mailing address:
  • Phone: 954-438-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801082210
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: