Healthcare Provider Details

I. General information

NPI: 1184533010
Provider Name (Legal Business Name): CHANNA GOLDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 W 25TH ST
NEW YORK NY
10001-7405
US

IV. Provider business mailing address

223 WILSON AVE
BROOKLYN NY
11237-4108
US

V. Phone/Fax

Practice location:
  • Phone: 646-655-9172
  • Fax:
Mailing address:
  • Phone: 518-932-8824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: