Provider Demographics
NPI:1346764255
Name:GORIN, REBECCA (LMFT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GORIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 5TH ST STE 100-532
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1400
Mailing Address - Country:US
Mailing Address - Phone:802-881-1245
Mailing Address - Fax:
Practice Address - Street 1:1212 5TH ST STE 100-532
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1400
Practice Address - Country:US
Practice Address - Phone:802-881-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0001940106H00000X
CA119099106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist