Provider Demographics
NPI:1518527712
Name:GOLDSTEIN, DAVID ALLEN (PHD, PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLEN
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 WILSHIRE BLVD.
Mailing Address - Street 2:SUITE 515
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-208-0107
Mailing Address - Fax:818-385-0307
Practice Address - Street 1:12301 WILSHIRE BLVD.
Practice Address - Street 2:SUITE 515
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-208-0107
Practice Address - Fax:818-385-0307
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT22917106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist