MEDICARE: MRS. ROSLYN MARIE GOLDNER 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
1	103T00000X	Psychologist	PR00186101	NY
2	1041C0700X	Clinical Social Worker	PR00186101	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	108174	OTHER		MHN
2	0023660	OTHER		GHI

General Provider Information

NPI Number	:	1295804383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROSLYN MARIE GOLDNER LCSW

Provider Business Mailing Address
First Line	:	25 RIVERS DR.
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11020
Country	:	US
Telephone Number	:	516-487-8383
Fax Number	:	516-773-3606

Provider Business Practice Location Address
First Line	:	25 RIVERS DR
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11020
Country	:	US
Telephone Number	:	516-487-8383
Fax Number	:	516-773-3606

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/01/2009

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