Provider Demographics
NPI:1962166322
Name:CASEY GOLDMAN, LCMHC
Entity type:Organization
Organization Name:CASEY GOLDMAN, LCMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:802-363-0001
Mailing Address - Street 1:489 ETHAN ALLEN PKWY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-1002
Mailing Address - Country:US
Mailing Address - Phone:802-363-0001
Mailing Address - Fax:
Practice Address - Street 1:6 OLDE ORCHARD PARK APT 641
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6971
Practice Address - Country:US
Practice Address - Phone:802-363-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty