Healthcare Provider Details

I. General information

NPI: 1558689604
Provider Name (Legal Business Name): REBECCA B. GOLEN M.S., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MONUMENT RD SUITE 207
BALA CYNWYD PA
19004-1702
US

IV. Provider business mailing address

2001 HAMILTON ST APT 301
PHILADELPHIA PA
19130-4201
US

V. Phone/Fax

Practice location:
  • Phone: 973-896-0394
  • Fax:
Mailing address:
  • Phone: 973-896-0394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDN005995
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: