Provider Demographics
NPI:1720121494
Name:GOLDBARD, LILLIAN N (LCSW)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:N
Last Name:GOLDBARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:
Other - Last Name:NISENBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:650 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2601
Mailing Address - Country:US
Mailing Address - Phone:408-793-5876
Mailing Address - Fax:408-275-6716
Practice Address - Street 1:650 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2601
Practice Address - Country:US
Practice Address - Phone:408-793-5870
Practice Address - Fax:408-275-6716
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 202241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P70021Medicare UPIN
ZZZ24376ZMedicare ID - Type Unspecified