Provider Demographics
NPI:1386023869
Name:AYO MARIA GOODEN, PH.D., ABPBC, LLC
Entity Type:Organization
Organization Name:AYO MARIA GOODEN, PH.D., ABPBC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AYO
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GOODEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-453-2849
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:WESTTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19395-0623
Mailing Address - Country:US
Mailing Address - Phone:610-453-2849
Mailing Address - Fax:484-315-8186
Practice Address - Street 1:1210 CHEYNEY RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-8502
Practice Address - Country:US
Practice Address - Phone:610-453-2849
Practice Address - Fax:484-315-8186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016573103T00000X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025453330001Medicaid
PA611990484Medicare PIN