1285650762 NPI number — MARILYN RENEE' GOLDMAN LCSW-C, LISW-CP

Table of content: MARILYN RENEE' GOLDMAN LCSW-C, LISW-CP (NPI 1285650762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285650762 NPI number — MARILYN RENEE' GOLDMAN LCSW-C, LISW-CP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDMAN
Provider First Name:
MARILYN
Provider Middle Name:
RENEE'
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C, LISW-CP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PLASTRIK
Provider Other First Name:
MARILYN
Provider Other Middle Name:
RENEE'
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285650762
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10960
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21234-0960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-882-7967
Provider Business Mailing Address Fax Number:
410-882-1079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 CHURCH LN STE 125
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIKESVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208-3786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-602-5166
Provider Business Practice Location Address Fax Number:
410-882-1079
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  12636 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 12412 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Y337 . This is a "CAREFIRST BLUECHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3507885 . This is a "CIGNA-HEALTHSPRING" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 732359 . This is a "BEACON HEALTH OPTIONS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 000641760 . This is a "OPTUM BEHAVIORAL HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 600010741 . This is a "MAGELLAN HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: C7WFMR . This is a "CAREFIRST BLUECROSS BLUESHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3846185 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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