Provider Demographics
NPI:1871897959
Name:JASON M GOLDBERG, LCSW-C, LLC
Entity type:Organization
Organization Name:JASON M GOLDBERG, LCSW-C, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPY
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:202-329-7696
Mailing Address - Street 1:4815 SAINT ELMO AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-7061
Mailing Address - Country:US
Mailing Address - Phone:301-664-6449
Mailing Address - Fax:301-664-7922
Practice Address - Street 1:4815 SAINT ELMO AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-7061
Practice Address - Country:US
Practice Address - Phone:301-664-6449
Practice Address - Fax:301-664-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD126971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty