Provider Demographics
NPI:1386941789
Name:DEBBIE N GOLDBERG LLC
Entity type:Organization
Organization Name:DEBBIE N GOLDBERG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:ICAADC, LPC, LLC
Authorized Official - Phone:717-953-9571
Mailing Address - Street 1:109 CHERRY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-3309
Mailing Address - Country:US
Mailing Address - Phone:717-953-9571
Mailing Address - Fax:717-953-9576
Practice Address - Street 1:27 SANDY LN STE 190
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1357
Practice Address - Country:US
Practice Address - Phone:717-953-9571
Practice Address - Fax:717-953-9576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11702063OtherCAQH