Provider Demographics
NPI:1144370487
Name:GOLDBERG, HELENE SYLVIA (CRC)
Entity type:Individual
Prefix:MS
First Name:HELENE
Middle Name:SYLVIA
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 FRANKLIN PLACE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598
Mailing Address - Country:US
Mailing Address - Phone:516-569-4526
Mailing Address - Fax:516-374-2132
Practice Address - Street 1:124 FRANKLIN PLACE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598
Practice Address - Country:US
Practice Address - Phone:516-569-4526
Practice Address - Fax:516-374-2132
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19424101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY19424OtherCRCC
NY00244817Medicaid
NY19424OtherCRCC