Provider Demographics
NPI:1215228747
Name:GOLDEN, LORI SUE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:SUE
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 MOUNT PUTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4750
Mailing Address - Country:US
Mailing Address - Phone:858-344-6045
Mailing Address - Fax:858-567-4462
Practice Address - Street 1:4315 MOUNT PUTMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4750
Practice Address - Country:US
Practice Address - Phone:858-344-6045
Practice Address - Fax:858-567-4462
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS11988102L00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical