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NPI Code Detail

MEDICARE: BROCK G GOLDSTEIN LCSW

MEDICARE: BROCK G GOLDSTEIN 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
1225400000XRehabilitation Practitioner
21041C0700XClinical Social Worker8152-CNV

General Provider Information

NPI Number : 1780986265
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROCK G GOLDSTEIN LCSW
Provider Business Mailing Address
First Line : 7860 W SAHARA AVE
Second Line : SUITE #170
City : LAS VEGAS
State : NV
Zip : 89117-1944
Country : US
Telephone Number : 407-758-3190
Fax Number :
Provider Business Practice Location Address
First Line : 6900 N PECOS RD # 4400
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89086-4400
Country : US
Telephone Number : 702-791-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2010
Last Update Date : 02/05/2026

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