Provider Demographics
NPI:1659888543
Name:DR. IRIT GOLDMAN PSY.D LMFT
Entity type:Organization
Organization Name:DR. IRIT GOLDMAN PSY.D LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. MFT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRIT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMFT
Authorized Official - Phone:209-605-9626
Mailing Address - Street 1:1604 FORD AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4649
Mailing Address - Country:US
Mailing Address - Phone:209-605-9626
Mailing Address - Fax:209-566-9561
Practice Address - Street 1:1604 FORD AVE STE 1
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4649
Practice Address - Country:US
Practice Address - Phone:209-605-9626
Practice Address - Fax:209-566-9561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFC46437106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty