Victor James Goldman, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSWR011981 Issued in NY

Practice address

1050 Hallock Ave
Suite 4
Port Jefferson Station, NY 11776-1214

Phone

(631) 928-4114

Fax

(631) 476-0766

NPI assigned

Jun 7, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2016 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1104866094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 HALLOCK AVE",
            "address_2": "SUITE 4",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761214",
            "telephone_number": "631-928-4114",
            "fax_number": "631-476-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 HALLOCK AVE",
            "address_2": "SUITE 4",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761214",
            "telephone_number": "631-928-4114",
            "fax_number": "631-476-0766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDMAN",
        "first_name": "VICTOR",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "LCSWR011981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Theresa Glaser, BCBA, LBA
• Nataliya Glazkova, RN
• Rachel Gabrielle Gmelin
• Theodore Goldberg, M.D.
• Robert Jay Goldman, D.D.S.
• Corey Golino, PHARM D
• Mehran Golpariani, MD
• Andrea Gomez Pereira, PHYSICIAN ASSISTANT
• Kayla Elizabeth Goncalves
• Caitlin Angelica Gonzalez

• Clinical Social Worker in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.