Provider Demographics
NPI:1972001840
Name:GOODMAN, NANCY REENA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:REENA
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ANN
Other - Last Name:STARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:714 S BELGRADE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3261
Mailing Address - Country:US
Mailing Address - Phone:201-674-4781
Mailing Address - Fax:
Practice Address - Street 1:714 S BELGRADE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3261
Practice Address - Country:US
Practice Address - Phone:201-674-4781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD139041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical