Provider Demographics
NPI:1871807503
Name:GOLDSMITH, DIANE BECK (LCSWC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:BECK
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:DEENA
Other - Middle Name:
Other - Last Name:GOLDSMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWC
Mailing Address - Street 1:10014 QUINBY ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-2119
Mailing Address - Country:US
Mailing Address - Phone:301-648-8328
Mailing Address - Fax:301-978-9753
Practice Address - Street 1:16220 FREDERICK RD
Practice Address - Street 2:SUITE 502
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4039
Practice Address - Country:US
Practice Address - Phone:301-978-9750
Practice Address - Fax:301-978-9753
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD085351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical