MEDICARE: CAROLYN GOLDSTEIN-HIDALGO

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	103K00000X	Behavior Analyst	1-16-22294	CO
2	106H00000X	Marriage & Family Therapist	MFC 52045	CA

General Provider Information

NPI Number	:	1770612814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN GOLDSTEIN-HIDALGO

Provider Business Mailing Address
First Line	:	2975 TREAT BLVD STE 5
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94518-3601
Country	:	US
Telephone Number	:	925-219-9009
Fax Number	:	925-940-9685

Provider Business Practice Location Address
First Line	:	2975 TREAT BLVD STE 5
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94518-3601
Country	:	US
Telephone Number	:	925-219-9009
Fax Number	:	925-940-9685

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	02/18/2020

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Directions to “ CAROLYN GOLDSTEIN-HIDALGO ” Practice Location

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