MEDICARE: MRS. PAMELA M GOLDBERG LMFT

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	106H00000X	Marriage & Family Therapist	LMFT07777	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LMFT0777	OTHER	NV	NEVADA STATE BOARD OF MARRIAGE AND FAMILY THERAPISTS

General Provider Information

NPI Number	:	1770715179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA M GOLDBERG LMFT

Provider Business Mailing Address
First Line	:	6284 S RAINBOW BLVD
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3244
Country	:	US
Telephone Number	:	702-257-0140
Fax Number	:	702-257-0139

Provider Business Practice Location Address
First Line	:	6284 S RAINBOW BLVD
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3244
Country	:	US
Telephone Number	:	702-257-0140
Fax Number	:	702-257-0139

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

Provider Enumeration Date	:	08/18/2009
Last Update Date	:	08/18/2009

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