MEDICARE: ADDISON GOLDEN

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	132546	CA

General Provider Information

NPI Number	:	1679050702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADDISON GOLDEN

Provider Business Mailing Address
First Line	:	848 16TH ST APT C
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-1814
Country	:	US
Telephone Number	:	520-461-7733
Fax Number	:

Provider Business Practice Location Address
First Line	:	848 16TH ST APT C
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-1814
Country	:	US
Telephone Number	:	520-461-7733
Fax Number	:

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

Provider Enumeration Date	:	07/21/2018
Last Update Date	:	01/08/2026

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Directions to “ ADDISON GOLDEN ” Practice Location

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