Healthcare Provider Details

I. General information

NPI: 1104620541
Provider Name (Legal Business Name): GOLDENROD THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 EDGEWATER DR # 27
ORLANDO FL
32804-3719
US

IV. Provider business mailing address

3019 EDGEWATER DR # 27
ORLANDO FL
32804-3719
US

V. Phone/Fax

Practice location:
  • Phone: 314-329-7091
  • Fax:
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: LINDSAY CHAMBERS
Title or Position: OWNER
Credential: LCSW
Phone: 314-329-7091