Provider Demographics
NPI:1821310459
Name:GOLDIN, MYRIAM LUCIA (LCSW, RPT-S)
Entity Type:Individual
Prefix:MRS
First Name:MYRIAM
Middle Name:LUCIA
Last Name:GOLDIN
Suffix:
Gender:F
Credentials:LCSW, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8626 LEE HWY
Mailing Address - Street 2:SUITE NUMBER 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2135
Mailing Address - Country:US
Mailing Address - Phone:703-980-2886
Mailing Address - Fax:
Practice Address - Street 1:8626 LEE HWY
Practice Address - Street 2:SUITE NUMBER 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2135
Practice Address - Country:US
Practice Address - Phone:703-980-2886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040056261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical