Provider Demographics
NPI:1043065386
Name:GOLDENBERG, LEAH GINA
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:GINA
Last Name:GOLDENBERG
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 1:144 OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5323
Mailing Address - Country:US
Mailing Address - Phone:864-336-2731
Mailing Address - Fax:833-740-3387
Practice Address - Street 1:300 BAKER AVE STE 300
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2124
Practice Address - Country:US
Practice Address - Phone:864-336-2731
Practice Address - Fax:833-740-3387
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW2289581041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker