Provider Demographics
NPI:1275513251
Name:CIRCLE TREATMENT CENTER PC
Entity Type:Organization
Organization Name:CIRCLE TREATMENT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALIND
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDFARB
Authorized Official - Suffix:
Authorized Official - Credentials:PH LCDC
Authorized Official - Phone:301-258-2626
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD2123103T00000X
MD4106103TA0400X
VA0810002291103TC0700X
103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD116981500Medicaid
MD283821OtherMEDICARE PTAN