Healthcare Provider Details

I. General information

NPI: 1740497114
Provider Name (Legal Business Name): ROBERT EDWARD GOLSKI MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 LEE ST
PERTH AMBOY NJ
08861-3053
US

IV. Provider business mailing address

17 S CLARK AVE
SOMERVILLE NJ
08876-3101
US

V. Phone/Fax

Practice location:
  • Phone: 732-442-1666
  • Fax: 732-442-9512
Mailing address:
  • Phone: 908-722-6433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number37PC00148300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: