1902820905 NPI number — MRS. LILLIAN JANINE GOLDFARB LCSW

Table of content: MRS. LILLIAN JANINE GOLDFARB LCSW (NPI 1902820905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902820905 NPI number — MRS. LILLIAN JANINE GOLDFARB LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDFARB
Provider First Name:
LILLIAN
Provider Middle Name:
JANINE
Provider Name Prefix Text:
MRS.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902820905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3916 CALLE VALLE VIS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBURY PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91320-1938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-490-0455
Provider Business Mailing Address Fax Number:
805-499-2433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30101 AGOURA CT STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGOURA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91301-5901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-490-0455
Provider Business Practice Location Address Fax Number:
805-499-2433
Provider Enumeration Date:
07/26/2006

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:  LCS17720 , 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)





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