Healthcare Provider Details

I. General information

NPI: 1467859462
Provider Name (Legal Business Name): AMY GOLDBERG LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CANAL ST SUITE A
SALEM MA
01970-4649
US

IV. Provider business mailing address

375 RANTOUL ST #307
BEVERLY MA
01915-3255
US

V. Phone/Fax

Practice location:
  • Phone: 978-744-1123
  • Fax:
Mailing address:
  • Phone: 978-471-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12130
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: