Healthcare Provider Details

I. General information

NPI: 1932724887
Provider Name (Legal Business Name): OVADIA GOLFEIZ LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 YORK RD
BALTIMORE MD
21212-3610
US

IV. Provider business mailing address

5820 YORK RD
BALTIMORE MD
21212-3610
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-2169
  • Fax:
Mailing address:
  • Phone: 410-800-2169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number23960
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: