Provider Demographics
NPI:1134287097
Name:COE, PETER GOODWIN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:GOODWIN
Last Name:COE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 OSCEOLA RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-2033
Mailing Address - Country:US
Mailing Address - Phone:202-721-2227
Mailing Address - Fax:
Practice Address - Street 1:4641 MONTGOMERY AVE
Practice Address - Street 2:#210
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3488
Practice Address - Country:US
Practice Address - Phone:202-721-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD036291041C0700X
DCLC3005631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical