Healthcare Provider Details

I. General information

NPI: 1104685148
Provider Name (Legal Business Name): CHELSEA ZARA GOLDBERGER LBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 JAYMOR RD
SOUTHAMPTON PA
18966-3826
US

IV. Provider business mailing address

6 CHESHIRE CT
HOLLAND PA
18966-2598
US

V. Phone/Fax

Practice location:
  • Phone: 215-330-4116
  • Fax:
Mailing address:
  • Phone: 267-288-3103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12688700
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH006587
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: