MEDICARE: MATHEW RYAN GOLDBERG

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	LCSW-5154	HI

General Provider Information

NPI Number	:	1477311520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATHEW RYAN GOLDBERG

Provider Business Mailing Address
First Line	:	11301 WILSHIRE BLVD BLDG 500
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90073-1003
Country	:	US
Telephone Number	:	747-955-6425
Fax Number	:

Provider Business Practice Location Address
First Line	:	11301 WILSHIRE BLVD BLDG 500
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90073-1003
Country	:	US
Telephone Number	:	747-955-6425
Fax Number	:

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

Provider Enumeration Date	:	03/12/2024
Last Update Date	:	12/04/2025

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