Provider Demographics
NPI:1114818069
Name:GOLDBERG, MICHELLE ELIZABETH (LAC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 STATE RT 10 STE 129
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-4539
Mailing Address - Country:US
Mailing Address - Phone:973-829-6960
Mailing Address - Fax:973-829-6960
Practice Address - Street 1:1719 STATE RT 10 STE 129
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4539
Practice Address - Country:US
Practice Address - Phone:973-829-6960
Practice Address - Fax:973-829-6960
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00688300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health