Healthcare Provider Details

I. General information

NPI: 1588140404
Provider Name (Legal Business Name): MICHELLE GOLDMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24302 NORTHERN BLVD
LITTLE NECK NY
11362-1199
US

IV. Provider business mailing address

24302 NORTHERN BLVD
LITTLE NECK NY
11362-1199
US

V. Phone/Fax

Practice location:
  • Phone: 718-423-6200
  • Fax:
Mailing address:
  • Phone: 718-423-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number103941
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: