Provider Demographics
NPI:1740725696
Name:GOLDSCHMIDT, LILIANA STARK
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:STARK
Last Name:GOLDSCHMIDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 PARK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-2277
Mailing Address - Country:US
Mailing Address - Phone:510-748-0640
Mailing Address - Fax:
Practice Address - Street 1:1335 PARK AVE STE A
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-2277
Practice Address - Country:US
Practice Address - Phone:510-748-0640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-02
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115138106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist