Provider Demographics
NPI:1679891790
Name:GOLDMAN, ANNETTE ROSA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:ROSA
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ANNETTE
Other - Middle Name:ROSA
Other - Last Name:GOLDMAN MOSQUEDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:731A 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-4020
Mailing Address - Country:US
Mailing Address - Phone:415-517-9235
Mailing Address - Fax:
Practice Address - Street 1:731A 2ND AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-4020
Practice Address - Country:US
Practice Address - Phone:415-517-9235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23504103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA97037OtherOLLIN
CA38932OtherAVIVA
CA38472OtherCASA QUETZAL