Provider Demographics
NPI:1861769911
Name:GOLDSTEIN, MAYA R (LCSW)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:R
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:S
Other - Last Name:RULNICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:292 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6307
Mailing Address - Country:US
Mailing Address - Phone:212-418-0330
Mailing Address - Fax:212-980-0073
Practice Address - Street 1:292 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6307
Practice Address - Country:US
Practice Address - Phone:212-418-0330
Practice Address - Fax:212-980-0073
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0764478-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical