Provider Demographics
NPI:1154766053
Name:GOLAN, LYNDA (LCSW)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:GOLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NE 81ST AVE UNIT 108
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-6967
Mailing Address - Country:US
Mailing Address - Phone:310-433-7288
Mailing Address - Fax:
Practice Address - Street 1:145 BAY ST UNIT 14
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1024
Practice Address - Country:US
Practice Address - Phone:310-433-7288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW154071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical