Healthcare Provider Details

I. General information

NPI: 1952542383
Provider Name (Legal Business Name): SULA GOLDENBERG LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2009
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 W MAIN ST STE 103
TUSTIN CA
92780-7712
US

IV. Provider business mailing address

PO BOX 881
TUSTIN CA
92781-0881
US

V. Phone/Fax

Practice location:
  • Phone: 714-376-7136
  • Fax:
Mailing address:
  • Phone: 714-376-7136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 46487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: