MEDICARE: MR. RONALD A GOLDSMITH ACSW, DCSW

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	I-05078	NM

General Provider Information

NPI Number	:	1477606390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD A GOLDSMITH ACSW, DCSW

Provider Business Mailing Address
First Line	:	1216 ALCAZAR ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7108
Country	:	US
Telephone Number	:	505-232-9516
Fax Number	:	505-232-9516

Provider Business Practice Location Address
First Line	:	1216 ALCAZAR ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7108
Country	:	US
Telephone Number	:	505-232-9516
Fax Number	:	505-232-9516

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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