Healthcare Provider Details

I. General information

NPI: 1457632549
Provider Name (Legal Business Name): JILL GUGGENHEIM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. JILL GUGGENHEIM

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 MANOR HOUSE DR
CHERRY HILL NJ
08003-5134
US

IV. Provider business mailing address

51 MANOR HOUSE DR
CHERRY HILL NJ
08003-5134
US

V. Phone/Fax

Practice location:
  • Phone: 856-565-8066
  • Fax:
Mailing address:
  • Phone: 856-565-8066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00546100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: