Provider Demographics
NPI:1033263538
Name:GOLDBERG, RAE ANN (MA)
Entity Type:Individual
Prefix:MS
First Name:RAE ANN
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1492
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-1492
Mailing Address - Country:US
Mailing Address - Phone:510-435-5858
Mailing Address - Fax:
Practice Address - Street 1:4101 MACDONALD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2333
Practice Address - Country:US
Practice Address - Phone:510-412-9200
Practice Address - Fax:510-412-9248
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2008-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41814106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist