Healthcare Provider Details

I. General information

NPI: 1760410302
Provider Name (Legal Business Name): MARGIE C GOLDBERG LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6449 WILSON MILLS ROAD
MAYFIELD VILLAGE OH
44143-3438
US

IV. Provider business mailing address

6449 WILSON MILLS ROAD
MAYFIELD VILLAGE OH
44143-3438
US

V. Phone/Fax

Practice location:
  • Phone: 440-442-8800
  • Fax: 440-442-8804
Mailing address:
  • Phone: 440-442-8800
  • Fax: 440-442-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0003431
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: