Provider Demographics
NPI:1811904253
Name:GOLDMAN, MARILYN (MFT)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:GOLDMAN
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 1:2934 LOMITA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3318
Mailing Address - Country:US
Mailing Address - Phone:805-687-3100
Mailing Address - Fax:
Practice Address - Street 1:2934 LOMITA RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3318
Practice Address - Country:US
Practice Address - Phone:805-687-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT23623106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist