MEDICARE: MRS. PENNY J GOLDBERG M.S.S. L.C.S.W.

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
1	1041C0700X	Clinical Social Worker	CW013633	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	742870	OTHER	PA	PART B NON-PHYSICIAN SPECIALTIES

General Provider Information

NPI Number	:	1275505075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PENNY J GOLDBERG M.S.S. L.C.S.W.

Provider Business Mailing Address
First Line	:	508 PRESCOTT RD
Second Line	:
City	:	MERION STATION
State	:	PA
Zip	:	19066-1041
Country	:	US
Telephone Number	:	610-667-0112
Fax Number	:	484-615-6080

Provider Business Practice Location Address
First Line	:	508 PRESCOTT RD
Second Line	:
City	:	MERION STATION
State	:	PA
Zip	:	19066-1041
Country	:	US
Telephone Number	:	610-667-0112
Fax Number	:	484-615-6080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	03/08/2010

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