Provider Demographics
NPI:1023148780
Name:GOUDARZNIA, FREYDUN FRED (MA LCPC)
Entity type:Individual
Prefix:MR
First Name:FREYDUN
Middle Name:FRED
Last Name:GOUDARZNIA
Suffix:
Gender:M
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 HUNGERFORD DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1713
Mailing Address - Country:US
Mailing Address - Phone:240-393-6720
Mailing Address - Fax:
Practice Address - Street 1:932 HUNGERFORD DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1713
Practice Address - Country:US
Practice Address - Phone:240-393-6720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC 0331101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health