Provider Demographics
NPI:1679923700
Name:GOLA, JENNIFER AMANDA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:AMANDA
Last Name:GOLA
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 1:1910 ROUTE 70 E
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2123
Mailing Address - Country:US
Mailing Address - Phone:856-220-9672
Mailing Address - Fax:856-673-0630
Practice Address - Street 1:1910 ROUTE 70 E
Practice Address - Street 2:SUITE 7
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2123
Practice Address - Country:US
Practice Address - Phone:856-220-9672
Practice Address - Fax:856-673-0630
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00563500103TB0200X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent