Provider Demographics
NPI:1871265876
Name:GOLDBERG, SUSAN ANN (LCSW-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ANN
Other - Last Name:GLOWACKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:1997 ANNAPOLIS EXCHANGE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3273
Mailing Address - Country:US
Mailing Address - Phone:410-635-1217
Mailing Address - Fax:
Practice Address - Street 1:1997 ANNAPOLIS EXCHANGE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3273
Practice Address - Country:US
Practice Address - Phone:410-635-1184
Practice Address - Fax:410-630-8087
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD275681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty