Healthcare Provider Details

I. General information

NPI: 1992166060
Provider Name (Legal Business Name): MADELEINE GOLDIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E PIER ST STE 2
PORT WASHINGTON WI
53074-1943
US

IV. Provider business mailing address

101 E PIER ST STE 2
PORT WASHINGTON WI
53074-1943
US

V. Phone/Fax

Practice location:
  • Phone: 262-284-5789
  • Fax: 262-284-5907
Mailing address:
  • Phone: 262-284-5789
  • Fax: 262-284-5907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9099-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: