Provider Demographics
NPI:1053417931
Name:GOLDMAN, CAROL A (LICSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:G
Other - Last Name:PALEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13 BOWDOIN ST
Mailing Address - Street 2:#1AB
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-523-0400
Mailing Address - Fax:617-523-0433
Practice Address - Street 1:13 BOWDOIN ST
Practice Address - Street 2:#1AB
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-523-0400
Practice Address - Fax:617-523-0433
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105520104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
P03469Medicare ID - Type Unspecified