Provider Demographics
NPI:1356113666
Name:GOODMAN, VICTORIA MERCEDES (LMSW)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:MERCEDES
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 ELKRIDGE LANDING RD STE 350
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2953
Mailing Address - Country:US
Mailing Address - Phone:443-354-8903
Mailing Address - Fax:443-410-0643
Practice Address - Street 1:939 ELKRIDGE LANDING RD STE 350
Practice Address - Street 2:
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-2953
Practice Address - Country:US
Practice Address - Phone:443-354-8903
Practice Address - Fax:443-410-0643
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30792104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker