Basic Information
| Provider Information | |||||||||
| NPI: | 1417287053 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDFARB | ||||||||
| FirstName: | CORA | ||||||||
| MiddleName: | HANNAH | ||||||||
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| Credential: | LCAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3312 CRESCENT STREET #CC | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111061110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188020666 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 HOYT ST | ||||||||
| Address2: | 7TH FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112015809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188020666 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2010 | ||||||||
| LastUpdateDate: | 10/05/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | P64467 | NY | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 001376-1 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.