Provider Demographics
NPI:1972063840
Name:GOLDFARB, ANN AXELRAD (LCSW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:AXELRAD
Last Name:GOLDFARB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 VERONE ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-5513
Mailing Address - Country:US
Mailing Address - Phone:832-724-0814
Mailing Address - Fax:
Practice Address - Street 1:2006 COMMONWEALTH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-1804
Practice Address - Country:US
Practice Address - Phone:832-724-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
TX515401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical