Provider Demographics
NPI:1124247234
Name:GOLDFUS, TOBI BRENNEMAN (LCSW-C, BCD)
Entity type:Individual
Prefix:MRS
First Name:TOBI
Middle Name:BRENNEMAN
Last Name:GOLDFUS
Suffix:
Gender:F
Credentials:LCSW-C, BCD
Other - Prefix:MRS
Other - First Name:TOBI
Other - Middle Name:BRENNEMAN
Other - Last Name:GOLDFUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C, BCD
Mailing Address - Street 1:6920 PALACE CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-2743
Mailing Address - Country:US
Mailing Address - Phone:301-788-6653
Mailing Address - Fax:
Practice Address - Street 1:20528 BOLAND FARM RD
Practice Address - Street 2:SUITE 217
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4021
Practice Address - Country:US
Practice Address - Phone:301-916-9739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD038091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD03809OtherLICENSE