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Individual

JACOB GOLDSTEIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
2506 WILLOWBROOK PKWY, INDIANAPOLIS, IN 46205-1564
(765) 288-1928
(317) 217-1769
Mailing address
240 N TILLOTSON AVE, MUNCIE, IN 47304-3988
(765) 288-1928
(765) 741-0335

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87000403A
IN
1041C0700X
Clinical Social Worker
Primary
34006843A
IN

Other

Enumeration date
07/03/2014
Last updated
06/08/2015
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