MEDICARE: HEATHER GOLDFARB LCSW L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	12224	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194700278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER GOLDFARB LCSW L

Provider Business Mailing Address
First Line	:	5257 BUCKEYSTOWN PIKE # 496
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21704-7535
Country	:	US
Telephone Number	:	240-674-5485
Fax Number	:

Provider Business Practice Location Address
First Line	:	5257 BUCKEYSTOWN PIKE # 496
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21704-7535
Country	:	US
Telephone Number	:	240-674-5485
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	10/20/2013

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