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General NPI Number Information
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NPI Number | 1336257401
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Entity Type | Individual
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Provider Name | JEANINE H GOLDSMITH LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 08/01/2018
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Provider Practice Location Address
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Address Line | 2070 DEER PARK AVE STE D
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City | DEER PARK
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State | NY
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Zip | 11729-2134
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Country | US
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Telephone | 631-522-1888
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Fax | 631-522-1889
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Provider Business Mailing Address
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Address Line | 56 CEDAR DR
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City | FARMINGDALE
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State | NY
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Zip | 11735-2902
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Country | US
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Telephone | 631-833-1700
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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 | 072309
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License Number State | NY
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