Provider Demographics
NPI:1386275386
Name:GOLDSTEIN, JENNIFER EVE (LMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EVE
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 OCEAN PKWY APT 2M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5163
Mailing Address - Country:US
Mailing Address - Phone:516-297-8035
Mailing Address - Fax:
Practice Address - Street 1:1225 OCEAN PKWY APT 2M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5163
Practice Address - Country:US
Practice Address - Phone:516-297-8035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076564104100000X
NY076564-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker