Provider Demographics
NPI:1447321500
Name:GOODSTEIN, ANN L (DSW)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:L
Last Name:GOODSTEIN
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 E MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2888
Mailing Address - Country:US
Mailing Address - Phone:631-360-3535
Mailing Address - Fax:631-360-1394
Practice Address - Street 1:180 E MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2888
Practice Address - Country:US
Practice Address - Phone:631-360-3535
Practice Address - Fax:631-360-1394
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO262951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN14901Medicare ID - Type Unspecified