Provider Demographics
NPI:1235345455
Name:GOLDIN, JENNIFER ELAINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELAINE
Last Name:GOLDIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N KENTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-2718
Mailing Address - Country:US
Mailing Address - Phone:310-475-3132
Mailing Address - Fax:310-440-0298
Practice Address - Street 1:10436 SANTA MONICA BOULEVARD
Practice Address - Street 2:SUITE 90025
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-475-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19715103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical