Provider Demographics
NPI:1306978291
Name:GOBERMAN, EDITH G (MFT)
Entity type:Individual
Prefix:DR
First Name:EDITH
Middle Name:G
Last Name:GOBERMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7968 ARJONS DR
Mailing Address - Street 2:SUIT D
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-6362
Mailing Address - Country:US
Mailing Address - Phone:858-610-2080
Mailing Address - Fax:858-530-0005
Practice Address - Street 1:11255 LAKERIM RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-2312
Practice Address - Country:US
Practice Address - Phone:858-610-2080
Practice Address - Fax:858-530-0005
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40281101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional