Provider Demographics
NPI:1922069202
Name:GOLDBERG, RICHARD WARREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WARREN
Last Name:GOLDBERG
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 1:737 W LOMBARD ST
Mailing Address - Street 2:SUITE 500A/B
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1009
Mailing Address - Country:US
Mailing Address - Phone:410-706-8473
Mailing Address - Fax:
Practice Address - Street 1:737 W LOMBARD ST
Practice Address - Street 2:SUITE 500 A/B
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1009
Practice Address - Country:US
Practice Address - Phone:410-706-8473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03191103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical