Provider Demographics
NPI:1528335510
Name:GOFF, ANNE VALERIO (LCSW-R)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:VALERIO
Last Name:GOFF
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CARDINAL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SAND LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12196-2101
Mailing Address - Country:US
Mailing Address - Phone:518-712-5037
Mailing Address - Fax:
Practice Address - Street 1:10 EMPIRE STATE BLVD.
Practice Address - Street 2:QUESTAR III
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033
Practice Address - Country:US
Practice Address - Phone:518-477-8771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053558-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool