Provider Demographics
NPI:1548818123
Name:GOLDSTEIN, KAELEN MARIE
Entity type:Individual
Prefix:MS
First Name:KAELEN
Middle Name:MARIE
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 E 4TH ST STE 256
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5171
Mailing Address - Country:US
Mailing Address - Phone:385-429-2604
Mailing Address - Fax:
Practice Address - Street 1:1633 E 4TH ST STE 256
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5171
Practice Address - Country:US
Practice Address - Phone:385-429-2604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14117101YM0800X
CA129946106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health