Provider Demographics
NPI:1194946756
Name:GOLDSMITH, DAVID MARC (LCSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MARC
Last Name:GOLDSMITH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 KEELER PLACE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:16877
Mailing Address - Country:US
Mailing Address - Phone:203-778-0078
Mailing Address - Fax:203-791-0742
Practice Address - Street 1:80 GROVE STREET
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877
Practice Address - Country:US
Practice Address - Phone:203-431-0401
Practice Address - Fax:203-791-0742
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0028811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical