Provider Demographics
NPI:1134311947
Name:GOLDING, JACQUELINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:GOLDING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SANTA RITA RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566
Mailing Address - Country:US
Mailing Address - Phone:925-484-2237
Mailing Address - Fax:925-484-1879
Practice Address - Street 1:1400 SANTA RITA RD
Practice Address - Street 2:SUITE K
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566
Practice Address - Country:US
Practice Address - Phone:925-484-2237
Practice Address - Fax:925-484-1879
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16104103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent