Provider Demographics
NPI:1285650762
Name:GOLDMAN, MARILYN RENEE' (LCSW-C, LISW-CP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:RENEE'
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:LCSW-C, LISW-CP
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:RENEE'
Other - Last Name:PLASTRIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10960
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-0960
Mailing Address - Country:US
Mailing Address - Phone:410-882-7967
Mailing Address - Fax:410-882-1079
Practice Address - Street 1:104 CHURCH LN STE 125
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3786
Practice Address - Country:US
Practice Address - Phone:410-602-5166
Practice Address - Fax:410-882-1079
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC126361041C0700X
MD124121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDY337OtherCAREFIRST BLUECHOICE
MD3507885OtherCIGNA-HEALTHSPRING
MD732359OtherBEACON HEALTH OPTIONS
MD000641760OtherOPTUM BEHAVIORAL HEALTH
MD600010741OtherMAGELLAN HEALTHCARE
MDC7WFMROtherCAREFIRST BLUECROSS BLUESHIELD
MD3846185OtherCIGNA