Provider Demographics
NPI:1861721243
Name:JASON M. GOLDBERG, LCSW-C
Entity type:Organization
Organization Name:JASON M. GOLDBERG, LCSW-C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PSYCHOTHERAPY PRACTICE
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:202-329-7696
Mailing Address - Street 1:4401 E WEST HWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4523
Mailing Address - Country:US
Mailing Address - Phone:202-329-7696
Mailing Address - Fax:301-907-3342
Practice Address - Street 1:4401 E WEST HWY
Practice Address - Street 2:SUITE 207
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4523
Practice Address - Country:US
Practice Address - Phone:202-329-7696
Practice Address - Fax:301-907-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD126971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty