Provider Demographics
NPI:1912211830
Name:GOLDMAN, ALISON MARA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:MARA
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ALISON
Other - Middle Name:MARA
Other - Last Name:GOLDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:333 HAYES ST
Mailing Address - Street 2:STE 210
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4459
Mailing Address - Country:US
Mailing Address - Phone:415-644-8095
Mailing Address - Fax:
Practice Address - Street 1:333 HAYES ST
Practice Address - Street 2:STE 210
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4459
Practice Address - Country:US
Practice Address - Phone:415-644-8095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical