Healthcare Provider Details

I. General information

NPI: 1457270837
Provider Name (Legal Business Name): GREGORY GOLDMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5632 VAN NUYS BLVD # 1211
SHERMAN OAKS CA
91401-4602
US

IV. Provider business mailing address

5632 VAN NUYS BLVD # 1211
SHERMAN OAKS CA
91401-4602
US

V. Phone/Fax

Practice location:
  • Phone: 424-253-4820
  • Fax:
Mailing address:
  • Phone: 424-253-4820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT153622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: