MEDICARE: LAURA GOLDENBERG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	12639	CA

General Provider Information

NPI Number	:	1093185738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA GOLDENBERG

Provider Business Mailing Address
First Line	:	2 PADRE PKWY STE 100
Second Line	:
City	:	ROHNERT PARK
State	:	CA
Zip	:	94928-2114
Country	:	US
Telephone Number	:	707-322-7085
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 PADRE PKWY STE 100
Second Line	:
City	:	ROHNERT PARK
State	:	CA
Zip	:	94928-2114
Country	:	US
Telephone Number	:	707-322-7085
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2015
Last Update Date	:	10/26/2015

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Directions to “ LAURA GOLDENBERG ” Practice Location

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