Provider Demographics
NPI:1497865430
Name:GOLDBERG, NOEL A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:A
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 MAPLE AVE W STE F
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5614
Mailing Address - Country:US
Mailing Address - Phone:703-935-0058
Mailing Address - Fax:703-935-0057
Practice Address - Street 1:360 MAPLE AVE W STE F
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5614
Practice Address - Country:US
Practice Address - Phone:703-935-0058
Practice Address - Fax:703-935-0057
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000358103TC0700X
VA0810003320103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical