Healthcare Provider Details

I. General information

NPI: 1841917564
Provider Name (Legal Business Name): JENNA EDEN GOLDSTEIN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 E IMPERIAL HWY STE 220
LYNWOOD CA
90262-2663
US

IV. Provider business mailing address

3680 E IMPERIAL HWY STE 220
LYNWOOD CA
90262-2663
US

V. Phone/Fax

Practice location:
  • Phone: 323-769-7174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number106016
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number106016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: