Doctor Name: | MS. JESSA METCALFE GOLDSTEIN |
NPI Number: | 1164806113 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 1870 19th St San Pablo, CA - 948064484 |
Business Phone Number: | 5102311420 |
Business Fax Number: | |
Mailing Address: | 3219 Pierce St, RICHMOND |
State: | CA |
Postal Code: | 948045910 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/18/2015 |
NPI Last Update Date: | 07/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |