Provider Demographics
NPI:1891404034
Name:BROGDIN, GOLDA (SUD RADT-1)
Entity type:Individual
Prefix:
First Name:GOLDA
Middle Name:
Last Name:BROGDIN
Suffix:
Gender:F
Credentials:SUD RADT-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 TOWER WAY STE 140
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1586
Mailing Address - Country:US
Mailing Address - Phone:661-634-9877
Mailing Address - Fax:
Practice Address - Street 1:1001 TOWER WAY STE 140
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1586
Practice Address - Country:US
Practice Address - Phone:661-634-9877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)