Provider Demographics
NPI:1750614004
Name:GOLDSTEIN, CHARI LYNN (MFT)
Entity type:Individual
Prefix:
First Name:CHARI
Middle Name:LYNN
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 MARINA VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3253
Mailing Address - Country:US
Mailing Address - Phone:415-412-2294
Mailing Address - Fax:707-297-6487
Practice Address - Street 1:638 1/2 1ST ST
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3082
Practice Address - Country:US
Practice Address - Phone:415-412-2294
Practice Address - Fax:707-297-6487
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42644106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist