Provider Demographics
NPI:1447750641
Name:GOULD, JENNIFER AGNES (MA, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:AGNES
Last Name:GOULD
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:AGNES
Other - Last Name:GERGELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 CHAIRVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9619
Mailing Address - Country:US
Mailing Address - Phone:609-388-8919
Mailing Address - Fax:
Practice Address - Street 1:11 CHAIRVILLE RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9619
Practice Address - Country:US
Practice Address - Phone:609-388-8919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013288101YM0800X
NJ37AC00403000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health