Provider Demographics
NPI:1851640940
Name:GOLDBERG, HOLLIE L (LISW S)
Entity type:Individual
Prefix:MS
First Name:HOLLIE
Middle Name:L
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LISW S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 FISHINGER ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2108
Mailing Address - Country:US
Mailing Address - Phone:614-457-7876
Mailing Address - Fax:614-457-1040
Practice Address - Street 1:1560 FISHINGER ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2108
Practice Address - Country:US
Practice Address - Phone:614-457-7876
Practice Address - Fax:614-457-1040
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0003308S101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health