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General NPI Number Information
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NPI Number | 1366561722
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Entity Type | Individual
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Provider Name | ELAINE S. GOLDBERG PHD
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 1424 HOWARD RD
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City | ANNAPOLIS
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State | MD
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Zip | 21403-4721
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Country | US
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Telephone | 301-275-3574
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Fax |
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Provider Business Mailing Address
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Address Line | 6 RIVIERA CT
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City | SILVER SPRING
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State | MD
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Zip | 20904-3585
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Country | US
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Telephone | 301-622-4614
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY03083
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 03083
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1768
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License Number State | DC
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