Healthcare Provider Details

I. General information

NPI: 1922192525
Provider Name (Legal Business Name): BARBARA Z GOLDSTEIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA-GLA-WLA 11301 WILSHIRE BLVD. WARD 2WCD
LOS ANGELES CA
90073
US

IV. Provider business mailing address

2734 FEDERAL AVE
LOS ANGELES CA
90064
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax: 310-268-4466
Mailing address:
  • Phone: 310-478-5280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 8211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: