Provider Demographics
NPI:1548694680
Name:KALETSKY GOLDBERG, REBECCA MICHELE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MICHELE
Last Name:KALETSKY GOLDBERG
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 1:646 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5322
Mailing Address - Country:US
Mailing Address - Phone:203-789-4038
Mailing Address - Fax:203-867-5279
Practice Address - Street 1:646 GEORGE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5322
Practice Address - Country:US
Practice Address - Phone:203-789-4038
Practice Address - Fax:203-867-5279
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0034401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical