Provider Demographics
NPI:1447635909
Name:GOLDENBERG, VICTORIA (MA, LCSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 E 66TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6324
Mailing Address - Country:US
Mailing Address - Phone:347-733-2424
Mailing Address - Fax:
Practice Address - Street 1:520 FRANKLIN AVE STE L21A
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5801
Practice Address - Country:US
Practice Address - Phone:347-927-9442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058128001041C0700X
NY095276104100000X
FLSW158071041C0700X
NY0887061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker