Provider Demographics
NPI:1013116474
Name:GOLDSTEIN, EVELYN (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
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 1:10411 BROOKMOOR DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-2603
Mailing Address - Country:US
Mailing Address - Phone:240-472-7045
Mailing Address - Fax:301-681-8597
Practice Address - Street 1:11235 OAK LEAF DR
Practice Address - Street 2:SUITE #110
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1318
Practice Address - Country:US
Practice Address - Phone:301-681-8597
Practice Address - Fax:301-598-6648
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical