Provider Demographics
NPI:1447413133
Name:RICHARD I. GOLDBERG, LLC
Entity Type:Organization
Organization Name:RICHARD I. GOLDBERG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:I
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-652-7792
Mailing Address - Street 1:7315 WISCONSIN AVE
Mailing Address - Street 2:SUITE 235 EAST
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3202
Mailing Address - Country:US
Mailing Address - Phone:301-652-7792
Mailing Address - Fax:
Practice Address - Street 1:7315 WISCONSIN AVE
Practice Address - Street 2:SUITE 235 EAST
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3202
Practice Address - Country:US
Practice Address - Phone:301-652-7792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD025911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty