Provider Demographics
NPI:1558689604
Name:GOLEN, REBECCA B (MS, RD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:B
Last Name:GOLEN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 HAMILTON ST
Mailing Address - Street 2:APT 301
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-4201
Mailing Address - Country:US
Mailing Address - Phone:973-896-0394
Mailing Address - Fax:
Practice Address - Street 1:150 MONUMENT RD
Practice Address - Street 2:SUITE 207
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1702
Practice Address - Country:US
Practice Address - Phone:973-896-0394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PADN005995133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)