Provider Demographics
NPI:1104858679
Name:MICHELSON, GOLDA BETH (MFT)
Entity Type:Individual
Prefix:MS
First Name:GOLDA
Middle Name:BETH
Last Name:MICHELSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 D ST STE C
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3708
Mailing Address - Country:US
Mailing Address - Phone:415-272-0804
Mailing Address - Fax:415-456-2554
Practice Address - Street 1:610 D ST STE C
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3708
Practice Address - Country:US
Practice Address - Phone:415-272-0804
Practice Address - Fax:415-456-2554
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 13435106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist