Provider Demographics
NPI:1891702643
Name:GOLDBERG, SUZANNE M (DMH)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:DMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 Q ST NW
Mailing Address - Street 2:#2
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009
Mailing Address - Country:US
Mailing Address - Phone:202-588-0248
Mailing Address - Fax:
Practice Address - Street 1:2029 Q ST NW
Practice Address - Street 2:#2
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1058
Practice Address - Country:US
Practice Address - Phone:202-588-0248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1007103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010281229Medicaid
VA010281229Medicaid
DC408349Medicare PIN