Healthcare Provider Details

I. General information

NPI: 1194071787
Provider Name (Legal Business Name): DAVID T GOLDBERG LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 BRONX BLVD
BRONX NY
10470-1407
US

IV. Provider business mailing address

4401 BRONX BLVD
BRONX NY
10470-1407
US

V. Phone/Fax

Practice location:
  • Phone: 718-304-7000
  • Fax: 718-304-7065
Mailing address:
  • Phone: 718-304-7000
  • Fax: 718-304-7065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number078453-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: