MEDICARE: AMY GOLDSTEIN M.F.T.

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	MFC 39914	CA

General Provider Information

NPI Number	:	1962682336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY GOLDSTEIN M.F.T.

Provider Business Mailing Address
First Line	:	PO BOX 97
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90213-0097
Country	:	US
Telephone Number	:	310-652-0710
Fax Number	:

Provider Business Practice Location Address
First Line	:	329 N WETHERLY DR
Second Line	:	SUITE 204
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-1605
Country	:	US
Telephone Number	:	310-652-0710
Fax Number	:

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

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	11/13/2007

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