Provider Demographics
NPI:1447828884
Name:GOLDSBERRY, KERRY J (LISW)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:J
Last Name:GOLDSBERRY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 MIDDLE RD STE 602
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3289
Mailing Address - Country:US
Mailing Address - Phone:563-265-1529
Mailing Address - Fax:563-726-7500
Practice Address - Street 1:2550 MIDDLE RD STE 602
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3289
Practice Address - Country:US
Practice Address - Phone:563-265-1529
Practice Address - Fax:563-726-7500
Is Sole Proprietor?:No
Enumeration Date:2021-06-13
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1071391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical