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NPI Code Detail

MEDICARE: LISA GOODMAN NIEDERMAN LCSW

MEDICARE: LISA GOODMAN NIEDERMAN LCSW
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
11041C0700XClinical Social WorkerISW00498RI
21041C0700XClinical Social WorkerC009243NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
162-67493OTHERRIUBH
230118-1OTHERRIBLUE CROSS
3408503OTHERRIBLUE CHIP
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568470367
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA GOODMAN NIEDERMAN LCSW
Provider Business Mailing Address
First Line : 5730 EXECUTIVE DR STE 230
Second Line :
City : CATONSVILLE
State : MD
Zip : 21228-1762
Country : US
Telephone Number : 704-443-6250
Fax Number :
Provider Business Practice Location Address
First Line : 2030 WINDSOR RUN LN
Second Line :
City : MATTHEWS
State : NC
Zip : 28105-0054
Country : US
Telephone Number : 704-443-6250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2006
Last Update Date : 02/26/2026

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