Provider Demographics
NPI:1962987925
Name:GOLDFEDER, TANIA L (LCSW)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:L
Last Name:GOLDFEDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:GOLDFEDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1637
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-1637
Mailing Address - Country:US
Mailing Address - Phone:270-689-6500
Mailing Address - Fax:270-689-6677
Practice Address - Street 1:NEW MEXICO SOLUTIONS
Practice Address - Street 2:707 BROADWAY NE SUITE 500
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-268-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM10462104100000X
NMM-10462104100000X
NMC-115541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker