Healthcare Provider Details

I. General information

NPI: 1861805301
Provider Name (Legal Business Name): CHERYL GOLDSTEIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11911 SAN VICENTE BLVD #270
LOS ANGELES CA
90049-5086
US

IV. Provider business mailing address

PO BOX 1622
PACIFIC PALISADES CA
90272-1622
US

V. Phone/Fax

Practice location:
  • Phone: 323-905-4162
  • Fax:
Mailing address:
  • Phone: 323-905-4162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberRP 240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: