Healthcare Provider Details

I. General information

NPI: 1013024470
Provider Name (Legal Business Name): ANDREA B GOLDBERG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 BELLEVILLE AVE
BLOOMFIELD NJ
07003-3652
US

IV. Provider business mailing address

324 BELLEVILLE AVE
BLOOMFIELD NJ
07003-3652
US

V. Phone/Fax

Practice location:
  • Phone: 973-748-0045
  • Fax: 973-718-2902
Mailing address:
  • Phone: 973-748-0045
  • Fax: 973-718-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05082700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: