MEDICARE: MS. JANICE GOLDWATER 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	101YM0800X	Mental Health Counselor	4187	MD

General Provider Information

NPI Number	:	1740667674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANICE GOLDWATER LCSW-C

Provider Business Mailing Address
First Line	:	4061 POWDER MILL RD STE 320
Second Line	:
City	:	CALVERTON
State	:	MD
Zip	:	20705-3149
Country	:	US
Telephone Number	:	301-422-5125
Fax Number	:

Provider Business Practice Location Address
First Line	:	4061 POWDER MILL RD STE 320
Second Line	:
City	:	CALVERTON
State	:	MD
Zip	:	20705-3149
Country	:	US
Telephone Number	:	301-422-5125
Fax Number	:

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

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	04/29/2015

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