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NPI Code Detail

MEDICARE: ANDRIA GOLDMAN

MEDICARE: ANDRIA GOLDMAN
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
1101YM0800XMental Health CounselorIMH14930FL

General Provider Information

NPI Number : 1962944850
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDRIA GOLDMAN
Provider Business Mailing Address
First Line : 12424 BRANTLEY COMMONS CT
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-5680
Country : US
Telephone Number : 239-332-8009
Fax Number :
Provider Business Practice Location Address
First Line : 12424 BRANTLEY COMMONS CT
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-5680
Country : US
Telephone Number : 239-332-8009
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2016
Last Update Date : 11/09/2016

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