1962987925 NPI number — TANIA L GOLDFEDER LCSW

Table of content: TANIA L GOLDFEDER LCSW (NPI 1962987925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962987925 NPI number — TANIA L GOLDFEDER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDFEDER
Provider First Name:
TANIA
Provider Middle Name:
L
Provider Name Prefix Text:
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:
GOLDFEDER
Provider Other First Name:
TANIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1962987925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1637
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42302-1637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-689-6500
Provider Business Mailing Address Fax Number:
270-689-6677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NEW MEXICO SOLUTIONS
Provider Second Line Business Practice Location Address:
707 BROADWAY NE SUITE 500
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-268-0701
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2018

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: 104100000X , with the licence number:  10462 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: M-10462 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: C-11554 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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