MEDICARE: MS. ELISABETH EUGENIA GOLDENBERG MSW, QMHP

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	L5871	OR

General Provider Information

NPI Number	:	1801924253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELISABETH EUGENIA GOLDENBERG MSW, QMHP

Provider Business Mailing Address
First Line	:	4059 DONALD ST APT J
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-3971
Country	:	US
Telephone Number	:	541-517-2517
Fax Number	:

Provider Business Practice Location Address
First Line	:	2440 WILLAMETTE ST STE 201
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-3170
Country	:	US
Telephone Number	:	541-321-2278
Fax Number	:	541-246-8826

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	06/20/2023

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