Provider Demographics
NPI:1407297377
Name:GOITEIN, ALEXANDER (LCSW, PPSC, BCBA)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:GOITEIN
Suffix:
Gender:M
Credentials:LCSW, PPSC, BCBA
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:GOITEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3808 ZIEBER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-2636
Mailing Address - Country:US
Mailing Address - Phone:707-575-3290
Mailing Address - Fax:
Practice Address - Street 1:1028 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3596
Practice Address - Country:US
Practice Address - Phone:707-431-3488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-17837103K00000X
CA824001041C0700X
CAPPSC-2001458141041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical