Jeremiah Goldberg, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW018748 Issued in PA

Practice address

2050A 2ND St SE
Kirtland Afb, NM 87117-5003

Phone

(505) 846-3200

NPI assigned

Jul 30, 2013

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 4, 2021.

{
    "created_epoch": "1375142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1679905889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050A 2ND ST SE",
            "city": "KIRTLAND AFB",
            "state": "NM",
            "postal_code": "871175901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050A 2ND ST SE",
            "city": "KIRTLAND AFB",
            "state": "NM",
            "postal_code": "871175003",
            "telephone_number": "505-846-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDBERG",
        "first_name": "JEREMIAH",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-30",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW018748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven C. Fenzl, DDS
• Britney L Fiandra, RD
• Irene Folaron
• Francisco F. Gallardo Jr., DDS, MS
• Milad Gheisari, DDS
• Mariah Gordon
• Rebecca J Gottheimer, RDH
• B Thomas Hail, LCSW
• Kelly Lynn Hall, PA-C
• Brett Mason Harrell

• All providers in Kirtland Afb, NM
• Clinical Social Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.