Provider Demographics
NPI:1790986701
Name:GOGGIN, JENNIFER DANA (MA, LMHC, LPC, SEP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DANA
Last Name:GOGGIN
Suffix:
Gender:F
Credentials:MA, LMHC, LPC, SEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 MILL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-1511
Mailing Address - Country:US
Mailing Address - Phone:203-400-2343
Mailing Address - Fax:203-373-0835
Practice Address - Street 1:950 MILL CREEK DR
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-1511
Practice Address - Country:US
Practice Address - Phone:203-400-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040655Medicaid