Healthcare Provider Details

I. General information

NPI: 1306621131
Provider Name (Legal Business Name): ANDREA MERI GOLDEN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA MERI GOLDEN LCSW-C

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 09/03/2023
Certification Date: 09/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12646 GRANITE RIDGE DR
NORTH POTOMAC MD
20878-3466
US

IV. Provider business mailing address

12646 GRANITE RIDGE DR
NORTH POTOMAC MD
20878-3466
US

V. Phone/Fax

Practice location:
  • Phone: 240-994-8681
  • Fax:
Mailing address:
  • Phone: 240-994-8681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06250
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: