1497993778 NPI number — MS. MARCIA VERONICA GOLDEN LCSW

Table of content: MS. MARCIA VERONICA GOLDEN LCSW (NPI 1497993778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497993778 NPI number — MS. MARCIA VERONICA GOLDEN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDEN
Provider First Name:
MARCIA
Provider Middle Name:
VERONICA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOLDEN
Provider Other First Name:
MARCIA
Provider Other Middle Name:
VERONICA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1497993778
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1276 FULTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10456-3402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-579-7300
Provider Business Mailing Address Fax Number:
718-579-7356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 EAST 167 STREET
Provider Second Line Business Practice Location Address:
1276 FULTON AVE
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-579-7300
Provider Business Practice Location Address Fax Number:
718-579-7356
Provider Enumeration Date:
01/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  PRO 16566-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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