Provider Demographics
NPI:1447366497
Name:GOTTFRIED, CARYN DAY (MFT)
Entity type:Individual
Prefix:
First Name:CARYN
Middle Name:DAY
Last Name:GOTTFRIED
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 1:28 MIRAMONTE DR
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-1002
Mailing Address - Country:US
Mailing Address - Phone:510-531-0947
Mailing Address - Fax:
Practice Address - Street 1:21847 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-6435
Practice Address - Country:US
Practice Address - Phone:510-531-0947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT18876106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist