Provider Demographics
NPI:1972157006
Name:OPEN SPACE COUNSELING, CONSULTING & WELLNESS
Entity type:Organization
Organization Name:OPEN SPACE COUNSELING, CONSULTING & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:724-777-1433
Mailing Address - Street 1:101 BRADFORD RD STE 330
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-6938
Mailing Address - Country:US
Mailing Address - Phone:724-777-1433
Mailing Address - Fax:
Practice Address - Street 1:101 BRADFORD RD STE 330
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-6938
Practice Address - Country:US
Practice Address - Phone:724-777-1433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-26
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty