Provider Demographics
NPI:1841224938
Name:GOLDMAN, LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 WHITLEY DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-1456
Mailing Address - Country:US
Mailing Address - Phone:703-624-0223
Mailing Address - Fax:571-633-9798
Practice Address - Street 1:1495 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5727
Practice Address - Country:US
Practice Address - Phone:703-624-0223
Practice Address - Fax:571-633-9798
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002146103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7706472Medicaid
VAS38401Medicare UPIN