Active NPI
Bruce Edward Goldberg, MSW
- Mental Health Counselor
- Troy, MI
National Provider Identifier
1336297449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 6801069734
- Practice address
- 33975 Dequindre Rd
Suite 5
Troy, MI 48083-4649 - Phone
- (248) 421-0717
- NPI assigned
- Jan 8, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 6801069734 | MI | Primary |
Addresses
Primary practice location
33975 Dequindre Rd
Suite 5
Troy, MI 48083-4649
Mailing address
33975 Dequindre Rd
Suite 5
Troy, MI 48083-4649
Phone (248) 421-0717
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801069734 | MI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336297449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33975 DEQUINDRE RD",
"address_2": "SUITE 5",
"city": "TROY",
"state": "MI",
"postal_code": "480834649",
"telephone_number": "248-421-0717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33975 DEQUINDRE RD",
"address_2": "SUITE 5",
"city": "TROY",
"state": "MI",
"postal_code": "480834649",
"telephone_number": "248-421-0717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDBERG",
"first_name": "BRUCE",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"credential": "MSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MI",
"license": "6801069734",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.