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NPI Code Detail

MEDICARE: LISA GOLDENBERG L.C.S.W.

MEDICARE: LISA GOLDENBERG L.C.S.W.
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
11041C0700XClinical Social Worker001389CT

General Provider Information

NPI Number : 1801969704
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA GOLDENBERG L.C.S.W.
Provider Business Mailing Address
First Line : 79 SETH LOW MOUNTAIN ROAD
Second Line :
City : RIDGEFIELD
State : CT
Zip : 06877
Country : US
Telephone Number : 203-648-8342
Fax Number :
Provider Business Practice Location Address
First Line : 208 VALLEY RD
Second Line : JURGENSON BUILDING
City : NEW CANAAN
State : CT
Zip : 06840-3812
Country : US
Telephone Number : 203-801-2356
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2006
Last Update Date : 02/26/2009

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