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General NPI Number Information
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NPI Number | 1922069202
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Entity Type | Individual
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Provider Name | RICHARD WARREN GOLDBERG PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 737 W LOMBARD ST SUITE 500 A/B
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City | BALTIMORE
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State | MD
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Zip | 21201-1009
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Country | US
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Telephone | 410-706-8473
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Fax |
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Provider Business Mailing Address
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Address Line | 737 W LOMBARD ST SUITE 500A/B
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City | BALTIMORE
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State | MD
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Zip | 21201-1009
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Country | US
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Telephone | 410-706-8473
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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 | 03191
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License Number State | MD
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