Provider Demographics
NPI:1477369312
Name:EVANS-GOLDSTEIN, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:EVANS-GOLDSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 CLIPPER MILL RD STE 240
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1949
Mailing Address - Country:US
Mailing Address - Phone:443-386-6795
Mailing Address - Fax:
Practice Address - Street 1:3600 CLIPPER MILL RD STE 340
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1995
Practice Address - Country:US
Practice Address - Phone:443-990-1471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD323781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical