Active NPI
Peter David Goldberg, MS
- Marriage & Family Therapist
- Leesburg, VA
National Provider Identifier
1730299900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 0717001146
- Practice address
- 102 Heritage Way NE Ste 302
Leesburg, VA 20176-4544 - Phone
- (703) 771-5100
- Fax
- (703) 777-0170
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 0717001146 | VA | Primary |
Addresses
Primary practice location
102 Heritage Way NE Ste 302
Leesburg, VA 20176-4544
Mailing address
1606 Woodstock LN
Reston, VA 20194-1623
Phone (703) 282-0315
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0717001146 | VA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195171200000",
"number": "1730299900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1606 WOODSTOCK LN",
"city": "RESTON",
"state": "VA",
"postal_code": "201941623",
"telephone_number": "703-282-0315"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 HERITAGE WAY NE STE 302",
"city": "LEESBURG",
"state": "VA",
"postal_code": "201764544",
"telephone_number": "703-771-5100",
"fax_number": "703-777-0170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDBERG",
"first_name": "PETER",
"middle_name": "DAVID",
"credential": "MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2007-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "VA",
"license": "0717001146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leesburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.