Healthcare Provider Details

I. General information

NPI: 1801079322
Provider Name (Legal Business Name): JULIE GOLDBERG M.S., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1269 MAIN ST
CONCORD MA
01742-3099
US

IV. Provider business mailing address

208 WOLLASTON AVE
ARLINGTON MA
02476-7162
US

V. Phone/Fax

Practice location:
  • Phone: 978-287-7800
  • Fax:
Mailing address:
  • Phone: 781-646-5429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number178
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: