Provider Demographics
NPI:1487016663
Name:GOLDMAN, JUDY (LCSW)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-9347
Mailing Address - Country:US
Mailing Address - Phone:570-696-6890
Mailing Address - Fax:570-696-6890
Practice Address - Street 1:10 HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-9347
Practice Address - Country:US
Practice Address - Phone:570-696-6890
Practice Address - Fax:570-696-6890
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW015581101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health