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General NPI Number Information
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NPI Number | 1427150879
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Entity Type | Individual
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Provider Name | MARCIE ILENE GOLDMAN PHD
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Gender | Female
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 4452 PARK BLVD STE 101
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City | SAN DIEGO
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State | CA
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Zip | 92116-4039
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Country | US
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Telephone | 619-952-8077
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Fax | 619-239-7335
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Provider Business Mailing Address
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Address Line | 1332 BANCROFT ST
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City | SAN DIEGO
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State | CA
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Zip | 92102
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Country | US
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Telephone | 619-952-8077
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Fax | 619-239-7335
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY14404
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License Number State | CA
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