Provider Demographics
NPI:1043826860
Name:GOLDBERG, JESSICA ROCHELLE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ROCHELLE
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 1:116 MORGAN ST APT 44A
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5440
Mailing Address - Country:US
Mailing Address - Phone:201-566-1122
Mailing Address - Fax:
Practice Address - Street 1:116 MORGAN ST APT 44A
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5440
Practice Address - Country:US
Practice Address - Phone:201-566-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5290104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker