Provider Demographics
NPI:1427275700
Name:GOLDMAN, GERALDINE VICKI (CRC)
Entity type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:VICKI
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 TRINITY ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3222
Mailing Address - Country:US
Mailing Address - Phone:516-764-5744
Mailing Address - Fax:
Practice Address - Street 1:9502 ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-1317
Practice Address - Country:US
Practice Address - Phone:718-474-2478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00003406101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional