Healthcare Provider Details

I. General information

NPI: 1417206749
Provider Name (Legal Business Name): JAYNEE GOLDEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MOTOR AVE
LOS ANGELES CA
90034-3710
US

IV. Provider business mailing address

9461 CHARLEVILLE BLVD. #390
BEVERLY HILLS CA
90212
US

V. Phone/Fax

Practice location:
  • Phone: 310-361-1223
  • Fax:
Mailing address:
  • Phone: 424-274-2661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number80497
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW80497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: