Healthcare Provider Details

I. General information

NPI: 1568470367
Provider Name (Legal Business Name): LISA GOODMAN NIEDERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 WINDSOR RUN LN
MATTHEWS NC
28105-0054
US

IV. Provider business mailing address

5730 EXECUTIVE DR STE 230
CATONSVILLE MD
21228-1762
US

V. Phone/Fax

Practice location:
  • Phone: 704-443-6250
  • Fax:
Mailing address:
  • Phone: 704-443-6250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW00498
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC009243
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: