Provider Demographics
NPI:1588688485
Name:GOLDBERG, CANDICE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:CANDICE
Middle Name:
Last Name: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 1:215 WEST 88TH STREET
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1558
Mailing Address - Country:US
Mailing Address - Phone:212-696-7856
Mailing Address - Fax:
Practice Address - Street 1:215 WEST 88TH STREET
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6421
Practice Address - Country:US
Practice Address - Phone:212-696-7856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053626-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3131870OtherOXFORD PROVIDER ID NUMBER