Provider Demographics
NPI:1851746093
Name:GOODMAN, DIANNE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:GOODMAN
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 1:331 TRIMBLE RD APT B3
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-3819
Mailing Address - Country:US
Mailing Address - Phone:410-591-2801
Mailing Address - Fax:
Practice Address - Street 1:331 TRIMBLE RD APT B3
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3819
Practice Address - Country:US
Practice Address - Phone:410-591-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD170861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical