Healthcare Provider Details

I. General information

NPI: 1962153858
Provider Name (Legal Business Name): GOLDMAN CLINICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 MAPLE ST
SUMMIT NJ
07901-2529
US

IV. Provider business mailing address

37 MAPLE ST STE 4
SUMMIT NJ
07901-2529
US

V. Phone/Fax

Practice location:
  • Phone: 908-473-9964
  • Fax:
Mailing address:
  • Phone: 908-473-9964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL H GOLDMAN
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 908-473-9964