Healthcare Provider Details

I. General information

NPI: 1881172344
Provider Name (Legal Business Name): LISA GOLDFEIN LPCC, BC-DMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 GLADYS AVE
LONG BEACH CA
90804-4822
US

IV. Provider business mailing address

PO BOX 14788
LONG BEACH CA
90853-4788
US

V. Phone/Fax

Practice location:
  • Phone: 562-673-3143
  • Fax:
Mailing address:
  • Phone: 562-673-3143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1418
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number1157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: