Provider Demographics
NPI:1790129575
Name:GOLD, DONNA MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIE
Last Name:GOLD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11835 CARMEL MOUNTAIN ROAD
Mailing Address - Street 2:SUITE 1304, PMB 153
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128
Mailing Address - Country:US
Mailing Address - Phone:858-227-9182
Mailing Address - Fax:858-227-9477
Practice Address - Street 1:5440 MOREHOUSE DRIVE
Practice Address - Street 2:SUITE 3800
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:858-227-9182
Practice Address - Fax:858-227-9477
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA284941041C0700X
CALCS 284941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790129575Medicaid
CA1790129575OtherMEDICARE