Provider Demographics
NPI:1497985378
Name:GOODEN, AYO MARIA (PHD, ABPBC, LLC)
Entity Type:Individual
Prefix:DR
First Name:AYO
Middle Name:MARIA
Last Name:GOODEN
Suffix:
Gender:F
Credentials:PHD, ABPBC, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:610-399-0415
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:610-399-0415
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-25
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016573103T00000X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily