Healthcare Provider Details

I. General information

NPI: 1427126861
Provider Name (Legal Business Name): ELAINE EATON GOLDBERG LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7141 SECURITY BLVD WOODLAWN CENTER
BALTIMORE MD
21244-1811
US

IV. Provider business mailing address

7141 SECURITY BLVD WOODLAWN CENTER
BALTIMORE MD
21244-1811
US

V. Phone/Fax

Practice location:
  • Phone: 443-663-6016
  • Fax: 443-663-6302
Mailing address:
  • Phone: 443-663-6016
  • Fax: 443-663-6302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04012
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: