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NPI Code Detail

MEDICARE: MRS. MELISSA JILL GOLDMAN L.C.S.W.-R

MEDICARE: MRS. MELISSA JILL GOLDMAN L.C.S.W.-R
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 Worker069612-1NY

General Provider Information

NPI Number : 1447246848
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MELISSA JILL GOLDMAN L.C.S.W.-R
Provider Business Mailing Address
First Line : 217 N. MAPLE STREET
Second Line :
City : MASSAPEQUA
State : NY
Zip : 11758
Country : US
Telephone Number : 516-524-7076
Fax Number :
Provider Business Practice Location Address
First Line : 2277 GRAND AVE
Second Line :
City : BALDWIN
State : NY
Zip : 11510-3148
Country : US
Telephone Number : 516-546-6924
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2005
Last Update Date : 04/27/2015

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