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General NPI Number Information
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NPI Number | 1508353137
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Entity Type | Organization
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Legal Business Name | LITTLE SILVER BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 34 SYCAMORE AVE BLDG 2
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1228
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Country | US
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Telephone | 732-576-8925
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Fax | 732-576-8814
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Provider Business Mailing Address
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Address Line | 34 SYCAMORE AVE BLDG 2
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1228
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Country | US
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Telephone | 732-576-8925
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Fax | 732-576-8814
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID MICHAEL GOLDBERG
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Credential | PH,D,
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Telephone | 732-576-8925
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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 | 44SL05240800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35SI00345400
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License Number State | NJ
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