Provider Demographics
NPI:1487081121
Name:GOLDMAN, CASEY (LCMHC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8407
Mailing Address - Country:US
Mailing Address - Phone:802-363-0001
Mailing Address - Fax:802-419-3829
Practice Address - Street 1:6 OLDE ORCHARD PARK APT 641
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6971
Practice Address - Country:US
Practice Address - Phone:802-363-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0091180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1022367Medicaid