Provider Demographics
NPI:1649711334
Name:GOLDBERG, NICOLE FRIEDMAN (LMFT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:FRIEDMAN
Last Name:GOLDBERG
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4507 AUCKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-1502
Mailing Address - Country:US
Mailing Address - Phone:818-381-9965
Mailing Address - Fax:818-452-5985
Practice Address - Street 1:4507 AUCKLAND AVE
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-1502
Practice Address - Country:US
Practice Address - Phone:818-381-9965
Practice Address - Fax:818-452-5985
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96489106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist