Healthcare Provider Details

I. General information

NPI: 1366826083
Provider Name (Legal Business Name): MICHAEL S GOLDFADEN LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 GREENBRIAR LN
ANNAPOLIS MD
21401-4424
US

IV. Provider business mailing address

2610 GREENBRIAR LN
ANNAPOLIS MD
21401-4424
US

V. Phone/Fax

Practice location:
  • Phone: 410-269-5605
  • Fax: 410-268-6965
Mailing address:
  • Phone: 410-991-3292
  • Fax: 410-268-6965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29509
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAC0574
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: