Provider Demographics
NPI:1033482211
Name:GOLDSTEIN, CAROLYN R (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:R
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 WITTER RD.
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12009-3268
Mailing Address - Country:US
Mailing Address - Phone:518-872-0830
Mailing Address - Fax:
Practice Address - Street 1:259 WITTER RD.
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:NY
Practice Address - Zip Code:12009-3268
Practice Address - Country:US
Practice Address - Phone:518-872-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR034887-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical