Provider Demographics
NPI:1235415753
Name:GOLD, JOAN (MFT)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:GOLD
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 1:481 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-2151
Mailing Address - Country:US
Mailing Address - Phone:510-418-2387
Mailing Address - Fax:
Practice Address - Street 1:2931 SHATTUCK AVE STE 106
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1986
Practice Address - Country:US
Practice Address - Phone:510-418-2387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47108106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist