MEDICARE: DEANNA GOLDNER 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
1	1041C0700X	Clinical Social Worker	13934	SC
2	1041C0700X	Clinical Social Worker	012278	NC
3	1041C0700X	Clinical Social Worker	107401	TX

General Provider Information

NPI Number	:	1942609284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA GOLDNER LCSW

Provider Business Mailing Address
First Line	:	508 BOMAR ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-1407
Country	:	US
Telephone Number	:	908-723-3951
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 TRAVIS ST UNIT 207
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-2468
Country	:	US
Telephone Number	:	908-723-3951
Fax Number	:

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

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	09/20/2024

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