Healthcare Provider Details

I. General information

NPI: 1821732686
Provider Name (Legal Business Name): ELIZABETH HANNA GOLDBERG LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 DESALES ST NW FL 6
WASHINGTON DC
20036-4405
US

IV. Provider business mailing address

2714 ONTARIO RD NW UNIT 3
WASHINGTON DC
20009-2387
US

V. Phone/Fax

Practice location:
  • Phone: 201-803-1880
  • Fax:
Mailing address:
  • Phone: 201-803-1880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT1861
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: