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General NPI Number Information
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NPI Number | 1164806113
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Entity Type | Individual
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Provider Name | MS. JESSA METCALFE GOLDSTEIN
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Gender | Female
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Dates
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Enumeration Date | 07/18/2015
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 1870 19TH ST
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City | SAN PABLO
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State | CA
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Zip | 94806
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Country | US
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Telephone | 510-231-1420
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Fax |
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Provider Business Mailing Address
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Address Line | 11175 SAN PABLO AVE
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City | EL CERRITO
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State | CA
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Zip | 94530-2157
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Country | US
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Telephone | 510-426-6276
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 109065
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License Number State | CA
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