Provider Demographics
NPI:1619012630
Name:GOLDSTEIN, JEREEN MARIA (LPC, RN)
Entity Type:Individual
Prefix:MRS
First Name:JEREEN
Middle Name:MARIA
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:LPC, RN
Other - Prefix:
Other - First Name:JERI
Other - Middle Name:
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, RN
Mailing Address - Street 1:4425 E AGAVE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-0619
Mailing Address - Country:US
Mailing Address - Phone:480-753-5045
Mailing Address - Fax:
Practice Address - Street 1:4425 E AGAVE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-0619
Practice Address - Country:US
Practice Address - Phone:480-753-5045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 1272101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional