Active NPI
Marjorie Provost Goldbaum, LICSW LADC
- Clinical Social Worker
- Chelmsford, MA
National Provider Identifier
1407869704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 110711
- Practice address
- 201 Chelmsford St
Chelmsford, MA 01824-2359 - Phone
- (978) 256-1467
- Fax
- (978) 256-7465
- NPI assigned
- Aug 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 110711 | MA | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1530 | MA |
Addresses
Primary practice location
201 Chelmsford St
Chelmsford, MA 01824-2359
Mailing address
201 Chelmsford St
Chelmsford, MA 01824-2359
Phone (978) 256-1467
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1530 | MA | MD | Neurorehabilitation Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454371200000",
"number": "1407869704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 CHELMSFORD ST",
"city": "CHELMSFORD",
"state": "MA",
"postal_code": "018242359",
"telephone_number": "978-256-1467",
"fax_number": "978-256-7465"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 CHELMSFORD ST",
"city": "CHELMSFORD",
"state": "MA",
"postal_code": "018242359",
"telephone_number": "978-256-1467",
"fax_number": "978-256-7465"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDBAUM",
"first_name": "MARJORIE",
"middle_name": "PROVOST",
"credential": "LICSW LADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-15",
"last_updated": "2016-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "110711",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MA",
"license": "1530",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chelmsford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.