Basic Information
| Provider Information | |||||||||
| NPI: | 1639140932 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLD | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | SAMUEL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GOLD | ||||||||
| OtherFirstName: | CHAIM | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | LMSW | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 713 CROWN ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112135451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187351179 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 348 13TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112155004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187882461 | ||||||||
| FaxNumber: | 7187888274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YM0800X | 062878 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.