Provider Demographics
NPI:1225467335
Name:BAIRD-GOLDMAN, KRISTEN (MA)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:BAIRD-GOLDMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 VESPER AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1446
Mailing Address - Country:US
Mailing Address - Phone:310-779-4296
Mailing Address - Fax:
Practice Address - Street 1:15235 BURBANK BLVD STE B4
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91411-3556
Practice Address - Country:US
Practice Address - Phone:818-276-6826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF75752106H00000X
CA90662106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist