Provider Demographics
NPI:1699430405
Name:GOLDMAN, JOSHUA (LCSW)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 PALLANZA DR S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-3607
Mailing Address - Country:US
Mailing Address - Phone:727-515-3079
Mailing Address - Fax:
Practice Address - Street 1:2800 PALLANZA DR S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-3607
Practice Address - Country:US
Practice Address - Phone:727-515-3079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker