Provider Demographics
NPI:1952542383
Name:GOLDENBERG, SULA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SULA
Middle Name:
Last Name:GOLDENBERG
Suffix:
Gender:F
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:PO BOX 8042
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-8042
Mailing Address - Country:US
Mailing Address - Phone:714-376-7136
Mailing Address - Fax:714-543-6730
Practice Address - Street 1:1913 E 17TH ST
Practice Address - Street 2:
Practice Address - City:NORTH TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92705-8627
Practice Address - Country:US
Practice Address - Phone:714-376-7136
Practice Address - Fax:714-543-6730
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-15
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46487106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist