Healthcare Provider Details

I. General information

NPI: 1669087359
Provider Name (Legal Business Name): NEXT GENERATION NEUROPSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E EVESHAM RD STE 206
VOORHEES NJ
08043-4504
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: 856-528-5075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER WEST-GAVIN
Title or Position: OWNER
Credential: PSY.D
Phone: 856-818-6822