Healthcare Provider Details

I. General information

NPI: 1497386080
Provider Name (Legal Business Name): ELLEN MARGARET GOLDWASSER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5134 PEACHTREE RD
CHAMBLEE GA
30341-2724
US

IV. Provider business mailing address

1530 F ST UNIT 301
SACRAMENTO CA
95814-1676
US

V. Phone/Fax

Practice location:
  • Phone: 678-872-7100
  • Fax:
Mailing address:
  • Phone: 314-699-4216
  • Fax: 949-404-6103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2015012173
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW008407
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number88593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: