Provider Demographics
NPI:1992064885
Name:GOLDENBERG, JONAS B (MSW, LICSW)
Entity type:Individual
Prefix:MR
First Name:JONAS
Middle Name:B
Last Name:GOLDENBERG
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-2424
Mailing Address - Country:US
Mailing Address - Phone:508-259-0257
Mailing Address - Fax:
Practice Address - Street 1:262 DAVIS ST
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-2424
Practice Address - Country:US
Practice Address - Phone:508-259-0257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1167821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical