Provider Demographics
NPI:1932799764
Name:GOLDSTEIN, ABBY JAYE
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:JAYE
Last Name:GOLDSTEIN
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 1:2140 HOLLYRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-3515
Mailing Address - Country:US
Mailing Address - Phone:323-828-2589
Mailing Address - Fax:
Practice Address - Street 1:1555 W SUNSET BLVD UNIT C
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-3333
Practice Address - Country:US
Practice Address - Phone:323-828-2589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT112691106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist