Provider Demographics
NPI:1598095358
Name:GOLDSTEIN, MARK CHARLES (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:CHARLES
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13216 HAXTON PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1284
Mailing Address - Country:US
Mailing Address - Phone:805-217-2033
Mailing Address - Fax:
Practice Address - Street 1:12845 POINTE DEL MAR WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3862
Practice Address - Country:US
Practice Address - Phone:858-259-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106400000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist