Individual
JAY EZRA GOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Credential
LICSW, LADC
Contact information
Practice address
520 OSBORNE RD NE, FRIDLEY, MN 55432-2718
(763) 236-4579
(763) 236-4370
Mailing address
520 OSBORNE RD NE, FRIDLEY, MN 55432-2718
(763) 236-4579
(763) 236-4370
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
306430
MN
1041C0700X
Clinical Social Worker
Primary
13202
MN
Other
Enumeration date
11/01/2024
Last updated
11/01/2024
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