Provider Demographics
NPI:1568821684
Name:GOECKERMANN, CELIA
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:
Last Name:GOECKERMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 SOQUEL AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2301
Mailing Address - Country:US
Mailing Address - Phone:831-818-4833
Mailing Address - Fax:831-426-2803
Practice Address - Street 1:530 SOQUEL AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2301
Practice Address - Country:US
Practice Address - Phone:831-818-4833
Practice Address - Fax:831-426-2803
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33318106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist