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General NPI Number Information
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NPI Number | 1255897518
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Entity Type | Individual
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Provider Name | PETER GOLBORO LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/12/2019
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Last Update Date | 02/01/2021
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Provider Practice Location Address
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Address Line | 1 MALL DR STE 925
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City | CHERRY HILL
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State | NJ
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Zip | 08002-2110
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Country | US
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Telephone | 717-850-8720
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Fax |
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Provider Business Mailing Address
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Address Line | 33 E BROWNING RD APT 2A
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City | COLLINGSWOOD
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State | NJ
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Zip | 08108-1127
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Country | US
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Telephone | 610-787-9936
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05974800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL06262500
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW133566
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License Number State | PA
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