Provider Demographics
NPI:1386835643
Name:GOLDMAN, ANN E (LMFT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:GOLDMAN
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:PO BOX 3582
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92857-0582
Mailing Address - Country:US
Mailing Address - Phone:949-439-3959
Mailing Address - Fax:714-283-2884
Practice Address - Street 1:716 W TOWN AND COUNTRY RD
Practice Address - Street 2:STE B
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4710
Practice Address - Country:US
Practice Address - Phone:949-439-3959
Practice Address - Fax:714-283-5889
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39348106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist