Provider Demographics
NPI:1033557053
Name:GOLDBERG, REBECCA ADLER (MSW)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ADLER
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5703
Mailing Address - Country:US
Mailing Address - Phone:240-994-1653
Mailing Address - Fax:
Practice Address - Street 1:1483 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5703
Practice Address - Country:US
Practice Address - Phone:240-994-1653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16974104100000X
VA09040084711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD15485Medicaid