Provider Demographics
NPI:1316163629
Name:GOREN, ERIC (MFT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:GOREN
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 1:26060 VIA RIVIERA
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8316
Mailing Address - Country:US
Mailing Address - Phone:831-622-0326
Mailing Address - Fax:
Practice Address - Street 1:26060 VIA RIVIERA
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8316
Practice Address - Country:US
Practice Address - Phone:831-622-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32245106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC32245OtherMFT LICENSE