Provider Demographics
NPI:1306996517
Name:GOLD, JANE MADELINE (LMFT)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:MADELINE
Last Name:GOLD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:MADELINE
Other - Middle Name:JANE
Other - Last Name:GOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:555 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5064
Mailing Address - Country:US
Mailing Address - Phone:707-546-5400
Mailing Address - Fax:707-546-5400
Practice Address - Street 1:555 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5064
Practice Address - Country:US
Practice Address - Phone:707-546-5400
Practice Address - Fax:707-546-5400
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37626106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist