Healthcare Provider Details

I. General information

NPI: 1881000974
Provider Name (Legal Business Name): MEREDITH GOLDBERG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3073 S CHASE AVE STE 630
MILWAUKEE WI
53207-2668
US

IV. Provider business mailing address

3758 S IOWA AVE
ST FRANCIS WI
53235-4163
US

V. Phone/Fax

Practice location:
  • Phone: 414-501-3172
  • Fax:
Mailing address:
  • Phone: 414-748-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8561-123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number129101-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: