Provider Demographics
NPI:1124043807
Name:GOLDSTEIN, MILES GRANT (MSW)
Entity Type:Individual
Prefix:MR
First Name:MILES
Middle Name:GRANT
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N WASHINGTON ST
Mailing Address - Street 2:#410
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-2223
Mailing Address - Country:US
Mailing Address - Phone:301-738-2078
Mailing Address - Fax:301-738-1636
Practice Address - Street 1:110 N WASHINGTON ST
Practice Address - Street 2:#410
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2223
Practice Address - Country:US
Practice Address - Phone:301-738-2078
Practice Address - Fax:301-738-1636
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD038831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical