Healthcare Provider Details

I. General information

NPI: 1871258178
Provider Name (Legal Business Name): MARC GOLDMAN LMSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GENOA BUSINESS PARK DR STE 100
BRIGHTON MI
48114-5328
US

IV. Provider business mailing address

2200 GENOA BUSINESS PARK DR STE 100
BRIGHTON MI
48114-5328
US

V. Phone/Fax

Practice location:
  • Phone: 215-606-7171
  • Fax:
Mailing address:
  • Phone: 517-882-3732
  • Fax: 517-882-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW023664
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801116621
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: