Healthcare Provider Details

I. General information

NPI: 1386872638
Provider Name (Legal Business Name): SUSAN ALLEN GOLDMAN L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN ELLA ALLEN L.P.C.

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SPRING ROAD,NW 20010 L.H. PSYCHOLOGICAL
WASHINGTON DC
20010
US

IV. Provider business mailing address

959 MILLWOOD LN
GREAT FALLS VA
22066-2312
US

V. Phone/Fax

Practice location:
  • Phone: 202-506-3575
  • Fax: 202-506-3587
Mailing address:
  • Phone: 703-759-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC1050
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: