Provider Demographics
NPI:1992909709
Name:GOLDSTEIN, JUDITH (LCSWR)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:A
Other - Middle Name:JUDITH
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:142 GARTH ROAD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583
Mailing Address - Country:US
Mailing Address - Phone:914-725-5394
Mailing Address - Fax:
Practice Address - Street 1:142 GARTH ROAD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583
Practice Address - Country:US
Practice Address - Phone:914-725-5394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0348921104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
N56043Medicare ID - Type Unspecified