Provider Demographics
NPI:1255301495
Name:GOLDFARB, ROSALIND (PHD CCDC)
Entity Type:Individual
Prefix:DR
First Name:ROSALIND
Middle Name:
Last Name:GOLDFARB
Suffix:
Gender:F
Credentials:PHD CCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 SHIRLEY LN
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3906
Mailing Address - Country:US
Mailing Address - Phone:301-258-2626
Mailing Address - Fax:301-654-1612
Practice Address - Street 1:3309 SHIRLEY LN
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-3906
Practice Address - Country:US
Practice Address - Phone:301-258-2626
Practice Address - Fax:301-654-1612
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD2123103T00000X
MD4106103TA0400X
VA0810002291103TC0700X
MD02123103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD116981500Medicaid
MD283821OtherMEDICARE PTAN