Provider Demographics
NPI:1043022536
Name:GOLDBERG, ABIGAIL (LMSW)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 REMINGTON AVE APT E
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-3663
Mailing Address - Country:US
Mailing Address - Phone:315-857-5245
Mailing Address - Fax:
Practice Address - Street 1:118 REMINGTON AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-3683
Practice Address - Country:US
Practice Address - Phone:315-857-5245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122439104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker