Jay Ezra Gold, LICSW, LADC is a
Social Worker - Clinical based in Fridley, Minnesota. Jay Ezra Gold is licensed to practice in Minnesota (license number 13202) and current practice location is
520 Osborne Rd Ne, Fridley, Minnesota. can be reached at office (for appointments etc.) via phone at
(763) 236-4579.
NPI number for Jay Ezra Gold is 1871316547 and current mailing address is 520 Osborne Rd Ne, Fridley, Minnesota.
does not participate in medicare program and thus does not accept medicare assignments. NPI Number is 1871316547.
Healthcare Provider's Profile
Full Name | Jay Ezra Gold |
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Gender | |
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Speciality | Social Worker - Clinical |
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Location | 520 Osborne Rd Ne, Fridley, Minnesota |
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Accepts Medicare Assignments | Does not participate in Medicare Program. may not accept medicare assignment. |
NPI Data:
- NPI Number: 1871316547
- Provider Enumeration Date: 11/01/2024
- Last Update Date: 11/01/2024
Medical Identifiers
Medical identifiers for Jay Ezra Gold such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1871316547 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
101YA0400X | Counselor - Addiction (substance Use Disorder) | 306430 (Minnesota) | Secondary |
1041C0700X | Social Worker - Clinical | 13202 (Minnesota) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jay Ezra Gold is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Jay Ezra Gold, LICSW, LADC 520 Osborne Rd Ne, Fridley, MN 55432-2718 Ph: (763) 236-4579 | Jay Ezra Gold, LICSW, LADC 520 Osborne Rd Ne, Fridley, MN 55432-2718 Ph: (763) 236-4579 |
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