Provider Demographics
NPI:1871265876
Name:GOLDBERG, SUSAN ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ANN
Other - Last Name:GLOWACKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:9500 SINGLETON DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2559
Mailing Address - Country:US
Mailing Address - Phone:240-994-2331
Mailing Address - Fax:
Practice Address - Street 1:17904 GEORGIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2277
Practice Address - Country:US
Practice Address - Phone:240-304-3327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27568104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker