Provider Demographics
NPI:1801013206
Name:HOLDEN, JENNIFER JACKSON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JACKSON
Last Name:HOLDEN
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 1:125 COULTER AVE
Mailing Address - Street 2:CENTER FOR PSYCHOLOGICAL SERVICES
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2410
Mailing Address - Country:US
Mailing Address - Phone:610-642-4873
Mailing Address - Fax:
Practice Address - Street 1:41 LEOPARD RD STE 304
Practice Address - Street 2:CENTER FOR PSYCHOLOGICAL SERVICES
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1549
Practice Address - Country:US
Practice Address - Phone:610-647-6406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008633L103TC0700X
103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool