Basic Information
| Provider Information | |||||||||
| NPI: | 1083875736 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDSWER | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | L.C.S.W., L.I.S.W | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1090 W SOUTH BOUNDARY ST | ||||||||
| Address2: | |||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435515234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198738280 | ||||||||
| FaxNumber: | 4198738320 | ||||||||
| Practice Location | |||||||||
| Address1: | 1090 W SOUTH BOUNDARY ST | ||||||||
| Address2: | |||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435515234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198738280 | ||||||||
| FaxNumber: | 4198738320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2008 | ||||||||
| LastUpdateDate: | 03/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 070572 | NY | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | S1450317 | OH | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 082274-1 | NY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | I1450876 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.