Jake Edward Goldman | Santa Monica, CA • PECOS Search

Jake Edward Goldman

Marriage & Family Therapist

Behavioral Health & Social Service Providers

2730 Wilshire Blvd, Suite 630, Santa Monica, CA 90403-4743

PECOS Enrollment

Based on the most recent information from CMS, provider Jake Edward Goldman does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1982155198
Provider Type
Individual
Full Name
Goldman, Jake Edward
Title
Mr.
Credential
LMFT

Gender
Male
Sole Proprietor
Yes
Enumeration Date
10/23/2016
Last Updated
10/23/2016

Contact Information

Practice Location

2730 Wilshire Blvd, Suite 630, Santa Monica, CA 90403-4743

Unlisted Fax

Mailing Location

2730 Wilshire Blvd, Suite 630, Santa Monica, CA 90403-4743

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 106H00000X Primary	Description Marriage & Family Therapist Behavioral Health & Social Service Providers	License 51273 California