Provider Demographics
NPI:1437304482
Name:GOLDMAN, LORI BETH (MA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:BETH
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 QUINAN ST
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-1621
Mailing Address - Country:US
Mailing Address - Phone:510-214-0666
Mailing Address - Fax:
Practice Address - Street 1:668 QUINAN STREET
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564
Practice Address - Country:US
Practice Address - Phone:510-214-0666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist