Healthcare Provider Details

I. General information

NPI: 1063913176
Provider Name (Legal Business Name): JENNIFER WEST-GAVIN PSY. D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E EVESHAM RD STE 206
VOORHEES NJ
08043
US

IV. Provider business mailing address

2301 E EVESHAM RD STE 206
VOORHEES NJ
08043-4504
US

V. Phone/Fax

Practice location:
  • Phone: 856-472-6092
  • Fax:
Mailing address:
  • Phone: 856-472-6092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00589700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: