Provider Demographics
NPI:1982736278
Name:GOLDENBERG, CLIFFORD JAY (MFT)
Entity type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:JAY
Last Name:GOLDENBERG
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1972 EL DORADO AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2405
Mailing Address - Country:US
Mailing Address - Phone:510-524-2208
Mailing Address - Fax:
Practice Address - Street 1:2045 FRANCISCO ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-2125
Practice Address - Country:US
Practice Address - Phone:510-849-9401
Practice Address - Fax:510-841-3884
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT20060106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist