Healthcare Provider Details

I. General information

NPI: 1720713449
Provider Name (Legal Business Name): MARLA M GOLDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/18/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 US-1 BUSINESS
LAWRENCE NJ
08648
US

IV. Provider business mailing address

3 SAMS WAY
TRENTON NJ
08620-9779
US

V. Phone/Fax

Practice location:
  • Phone: 609-396-8877
  • Fax:
Mailing address:
  • Phone: 609-439-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: