Healthcare Provider Details

I. General information

NPI: 1346317021
Provider Name (Legal Business Name): MARIAN F. GOLDSTINE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E CALDER WAY SUITE 301
STATE COLLEGE PA
16801-4756
US

IV. Provider business mailing address

1639 GLENWOOD CIR
STATE COLLEGE PA
16803-3230
US

V. Phone/Fax

Practice location:
  • Phone: 814-867-4800
  • Fax: 814-206-7300
Mailing address:
  • Phone: 814-234-1359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW013735
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierCW013735
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerLICENSED CLINICAL SOCIAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: