Provider Demographics
NPI:1861559189
Name:GOLDFARB, MYRA RANNY
Entity type:Individual
Prefix:MS
First Name:MYRA
Middle Name:RANNY
Last Name:GOLDFARB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W 13TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7746
Mailing Address - Country:US
Mailing Address - Phone:212-620-7037
Mailing Address - Fax:
Practice Address - Street 1:230 W 13TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7746
Practice Address - Country:US
Practice Address - Phone:212-620-7037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR045698-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNOH69OtherEMPIRE-BLUE CROSS
NYNOH691Medicare ID - Type Unspecified