Healthcare Provider Details

I. General information

NPI: 1427266535
Provider Name (Legal Business Name): STEPHEN RANDY GOLDFINGER LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17810 WEXFORD TER
JAMAICA NY
11432-3050
US

IV. Provider business mailing address

102 E 22ND ST APARTMENT 5H
NEW YORK NY
10010-5404
US

V. Phone/Fax

Practice location:
  • Phone: 718-658-1123
  • Fax:
Mailing address:
  • Phone: 212-353-1648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number074713
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: