Provider Demographics
NPI:1407140965
Name:GOLDBERG, DARA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4853 CORDELL AVE
Mailing Address - Street 2:SUITE PH 12
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-7055
Mailing Address - Country:US
Mailing Address - Phone:301-908-2643
Mailing Address - Fax:
Practice Address - Street 1:4853 CORDELL AVE
Practice Address - Street 2:SUITE PH 12
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-7055
Practice Address - Country:US
Practice Address - Phone:301-908-2643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD140171041C0700X
DCLCD500789711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical