MEDICARE: MICHAEL S GOLDFADEN LCSW-C

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	1041C0700X	Clinical Social Worker	29509	MD
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	AC0574	MD

General Provider Information

NPI Number	:	1366826083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL S GOLDFADEN LCSW-C

Provider Business Mailing Address
First Line	:	2610 GREENBRIAR LN
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-4424
Country	:	US
Telephone Number	:	410-991-3292
Fax Number	:	410-268-6965

Provider Business Practice Location Address
First Line	:	2610 GREENBRIAR LN
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-4424
Country	:	US
Telephone Number	:	410-269-5605
Fax Number	:	410-268-6965

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

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	12/08/2025

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