Healthcare Provider Details

I. General information

NPI: 1417440082
Provider Name (Legal Business Name): LUKE ANDREW GOLDEN LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 W SEVENTH ST STE 500
FREDERICK MD
21701-8512
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR STE 730
GREENBELT MD
20770-3523
US

V. Phone/Fax

Practice location:
  • Phone: 301-345-1022
  • Fax:
Mailing address:
  • Phone: 301-345-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number23849
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: