Healthcare Provider Details

I. General information

NPI: 1023288297
Provider Name (Legal Business Name): ELIOT GEORGE GOLDMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

796H DREW ST
BROOKLYN NY
11208-4704
US

IV. Provider business mailing address

26 HALLEY DR
POMONA NY
10970-2003
US

V. Phone/Fax

Practice location:
  • Phone: 718-235-3100
  • Fax: 718-277-0822
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number008692
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: