Provider Demographics
NPI:1063112159
Name:DGOLDBERG MENTAL HEALTH COUNSELING, PLLC
Entity type:Organization
Organization Name:DGOLDBERG MENTAL HEALTH COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:W
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MA
Authorized Official - Phone:917-853-0211
Mailing Address - Street 1:PO BOX 944
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12789-0944
Mailing Address - Country:US
Mailing Address - Phone:917-853-0211
Mailing Address - Fax:845-400-2755
Practice Address - Street 1:7 ROBINS WAY
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12789-5323
Practice Address - Country:US
Practice Address - Phone:917-853-0211
Practice Address - Fax:845-400-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty