MEDICARE: ANITA B GOFFMAN 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	1041C0700X	Clinical Social Worker	R028118-1	NY

General Provider Information

NPI Number	:	1609047232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA B GOFFMAN LCSW

Provider Business Mailing Address
First Line	:	200 W 70TH ST
Second Line	:	# 9-H
City	:	NEW YORK
State	:	NY
Zip	:	10023-4323
Country	:	US
Telephone Number	:	212-769-8885
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W 70TH ST
Second Line	:	# 9-H
City	:	NEW YORK
State	:	NY
Zip	:	10023-4323
Country	:	US
Telephone Number	:	212-769-8885
Fax Number	:

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

Provider Enumeration Date	:	03/24/2008
Last Update Date	:	03/24/2008

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