Doctor Name: | MR. VICTOR JAMES GOLDMAN |
NPI Number: | 1104866094 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | LCSWR011981 |
Business Practice Address: | 1050 Hallock Ave Suite 4 Port Jefferson Station, NY - 117761214 |
Business Phone Number: | 6319284114 |
Business Fax Number: | 6314760766 |
Mailing Address: | 1050 Hallock Ave, Suite 4 PORT JEFFERSON STATION |
State: | NY |
Postal Code: | 117761214 |
Phone Number: | 6319284114 |
Fax Number: | 6314760766 |
NPI Enumeration Date: | 06/07/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LCSWR011981 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |