Provider Demographics
NPI:1891238333
Name:GOLDEN, JEREMIE SR
Entity Type:Individual
Prefix:
First Name:JEREMIE
Middle Name:
Last Name:GOLDEN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 HESSMER AVE
Mailing Address - Street 2:#112
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-7132
Mailing Address - Country:US
Mailing Address - Phone:901-230-5949
Mailing Address - Fax:
Practice Address - Street 1:3911 HESSMER AVE
Practice Address - Street 2:#112
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-7132
Practice Address - Country:US
Practice Address - Phone:901-230-5949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician