Basic Information
Provider Information
NPI: 1891823126
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOLDSTON
FirstName: STEVEN
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: LISW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6435 E. BROAD ST
Address2: SUITE A CHILDREN'S HOSPITAL GUIDANCE C
City: COLUMBUS
State: OH
PostalCode: 43213
CountryCode: US
TelephoneNumber: 6143558000
FaxNumber: 6143558018
Practice Location
Address1: 6435 E. BROAD ST
Address2: SUITE A CHILDREN'S HOSPITAL GUIDANCE CENTER
City: COLUMBUS
State: OH
PostalCode: 43213
CountryCode: US
TelephoneNumber: 6143558000
FaxNumber: 6143558018
Other Information
ProviderEnumerationDate: 02/28/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XI5135 Y Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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