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General NPI Number Information
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NPI Number | 1346413515
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Entity Type | Individual
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Provider Name | ALEX B GOLDMAN MA, LPC, CSAC
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Gender | Male
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 01/14/2020
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Provider Practice Location Address
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Address Line | 11414 W PARK PLACE SUITE 202
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City | MILWAUKEE
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State | WI
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Zip | 53224
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Country | US
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Telephone | 414-292-7060
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Fax | 414-871-9121
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Provider Business Mailing Address
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Address Line | 11414 W PARK PLACE SUITE 202
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City | MILWAUKEE
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State | WI
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Zip | 53224
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Country | US
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Telephone | 414-292-7060
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Fax | 888-965-2080
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 14468-132
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4808-125
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License Number State | WI
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