Provider Demographics
NPI:1891195319
Name:GOLDWATER, HARRY (LCSW-C)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:GOLDWATER
Suffix:
Gender:M
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 1:13804 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1052
Mailing Address - Country:US
Mailing Address - Phone:301-642-1553
Mailing Address - Fax:301-609-9091
Practice Address - Street 1:489 MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3187
Practice Address - Country:US
Practice Address - Phone:410-535-3047
Practice Address - Fax:301-609-9091
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18348101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health