MEDICARE: LEIGH GOLDMAN, LCSW LLC

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	1041S0200X	School Social Worker	741943	NJ
2	1041C0700X	Clinical Social Worker	44SC05473900	NJ

General Provider Information

NPI Number	:	1629421094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEIGH GOLDMAN, LCSW LLC

Provider Business Mailing Address
First Line	:	80 SCENIC DR STE 2
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-5211
Country	:	US
Telephone Number	:	609-795-1222
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 SCENIC DR STE 2
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-5211
Country	:	US
Telephone Number	:	609-795-1222
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LEIGH S GOLDMAN-HAMMER
Credential	:	LCSW
Telephone Number	:	609-795-1222

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	10/10/2022

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