Provider Demographics
NPI:1043706096
Name:GOLDMAN, DANIELLE R
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:R
Last Name:GOLDMAN
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:PO BOX 6691
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-6691
Mailing Address - Country:US
Mailing Address - Phone:805-312-8675
Mailing Address - Fax:
Practice Address - Street 1:23564 CALABASAS RD STE 208
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1339
Practice Address - Country:US
Practice Address - Phone:805-312-8675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2024-08-19
Deactivation Date:2019-08-13
Deactivation Code:
Reactivation Date:2019-08-29
Provider Licenses
StateLicense IDTaxonomies
101YS0200X
CA135053106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool