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General NPI Number Information
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NPI Number | 1295385136
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Entity Type | Individual
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Provider Name | ELISSA BETH GOLDSTEIN
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Gender | Female
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 1010 N CENTRAL AVE STE 310
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City | GLENDALE
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State | CA
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Zip | 91202-2937
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Country | US
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Telephone | 818-724-9770
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Fax | 818-484-2991
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Provider Business Mailing Address
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Address Line | 4428 TUJUNGA AVE APT 2
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91602-2073
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Country | US
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Telephone | 917-568-1231
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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 | 114867
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License Number State | CA
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