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NPI Code Detail

MEDICARE: MRS. ROBERTA S GOLANI MSW, LCSW

MEDICARE: MRS. ROBERTA S GOLANI MSW, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker34006485AIN
21041C0700XClinical Social Worker6801084724MI

General Provider Information

NPI Number : 1154676484
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ROBERTA S GOLANI MSW, LCSW
Provider Business Mailing Address
First Line : 3015 SEAFARER CV
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-8522
Country : US
Telephone Number : 260-471-2300
Fax Number :
Provider Business Practice Location Address
First Line : 3842 NEW VISION DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1708
Country : US
Telephone Number : 260-417-2300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2012
Last Update Date : 06/05/2015

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