Myra Goeller, MSW LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R049409 Issued in NY

Practice address

233 Seventh Ave
Suite 200
Garden City, NY 11530-5747

Phone

(516) 676-1722

Fax

(516) 676-4250

NPI assigned

Dec 20, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404777600000",
    "number": "1750445185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 SEVENTH AVE",
            "city": "SEA CLIFF",
            "state": "NY",
            "postal_code": "115791146",
            "telephone_number": "516-676-1722",
            "fax_number": "516-676-4250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 SEVENTH AVE",
            "address_2": "SUITE 200",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115305747",
            "telephone_number": "516-676-1722",
            "fax_number": "516-676-4250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOELLER",
        "first_name": "MYRA",
        "name_prefix": "Ms.",
        "credential": "MSW LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-20",
        "last_updated": "2014-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "6674",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "R049409-2",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R049409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI-BMP CITY OF NY",
            "identifier": "7482515",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "156994",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA BEHAVIORAL HEALTH",
            "identifier": "2108404",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02455392",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP",
            "identifier": "100674P",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHFIRST",
            "identifier": "049409-B37",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Garden City, NY
• Providers in Garden City, 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 8, 2014; 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.