=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477299345
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LYNN GOLDSTEIN, LCSW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2022
-----------------------------------------------------
Last Update Date | 05/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2470 JERUSALEM AVE
-----------------------------------------------------
City | N BELLMORE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11710-1827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-551-0320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46 PARKWAY DR
-----------------------------------------------------
City | SYOSSET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11791-6619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-551-0320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LCSW
-----------------------------------------------------
Name | LYNN A GOLDSTEIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-551-0320
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------