Provider Demographics
NPI:1003088956
Name:GOLIA, JENNIFER ANNE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:GOLIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MILL ST UNIT 317
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4563
Mailing Address - Country:US
Mailing Address - Phone:603-953-3386
Mailing Address - Fax:
Practice Address - Street 1:240 ISLINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7237
Practice Address - Country:US
Practice Address - Phone:603-953-3386
Practice Address - Fax:603-953-3386
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NH208106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99003227Medicaid
NH7706655Y0NH01OtherBHN
NH7706655Y0NH01OtherBHN