Healthcare Provider Details

I. General information

NPI: 1821244062
Provider Name (Legal Business Name): DELIA W GOLDBERG LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. DELIA ISRAEL

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 JEFFERSON STREET SUITE 1
MONTICELLO NY
12711
US

IV. Provider business mailing address

64 JEFFERSON ST.
MONTICELLO NY
12701
US

V. Phone/Fax

Practice location:
  • Phone: 845-791-8800
  • Fax: 845-791-7051
Mailing address:
  • Phone: 845-791-8800
  • Fax: 845-791-7051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number003266-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: