1972329621 NPI number — MRS. RYANA JANELLE GOLDBERGER LCSW, ACHP-SW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972329621 NPI number — MRS. RYANA JANELLE GOLDBERGER LCSW, ACHP-SW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDBERGER
Provider First Name:
RYANA
Provider Middle Name:
JANELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, ACHP-SW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KENELY
Provider Other First Name:
RYANA
Provider Other Middle Name:
JANELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972329621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4269 CALLE ISABELINO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92130-2656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-260-4081
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3252 HOLIDAY COURT
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-371-3737
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/26/2024

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:  LCS23190 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com