Provider Demographics
NPI:1194982108
Name:GOLDMAN, JUDITH GAIL (MSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:GAIL
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 EAST 12TH ST
Mailing Address - Street 2:#2A-F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-255-3792
Mailing Address - Fax:212-966-4216
Practice Address - Street 1:24 E 12TH ST
Practice Address - Street 2:#2A-F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-255-3792
Practice Address - Fax:212-966-4216
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR02267711041C0700X
NJ44SC007531001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical