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General NPI Number Information
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NPI Number | 1871897959
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Entity Type | Organization
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Legal Business Name | JASON M GOLDBERG, LCSW-C, LLC
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 05/09/2011
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Provider Practice Location Address
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Address Line | 4815 SAINT ELMO AVE SUITE 100
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City | BETHESDA
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State | MD
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Zip | 20814-7061
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Country | US
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Telephone | 301-664-6449
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Fax | 301-664-7922
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Provider Business Mailing Address
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Address Line | 4815 SAINT ELMO AVE SUITE 100
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City | BETHESDA
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State | MD
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Zip | 20814-7061
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Country | US
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Telephone | 301-664-6449
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Fax | 301-664-7922
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPY
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Name | MR. JASON MATTHEW GOLDBERG
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Credential | LCSW-C
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Telephone | 202-329-7696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12697
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License Number State | MD
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