Healthcare Provider Details

I. General information

NPI: 1285965962
Provider Name (Legal Business Name): JENNIFER ANN GOLDMAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6867 SOUTHPOINT DR N SUITE 106
JACKSONVILLE FL
32216-8043
US

IV. Provider business mailing address

6867 SOUTHPOINT DRIVE NORTH SUITE 106
JACKSONVILLE FL
32216
US

V. Phone/Fax

Practice location:
  • Phone: 904-619-6071
  • Fax:
Mailing address:
  • Phone: 904-619-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8029
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: