Provider Demographics
NPI:1669087359
Name:NEXT GENERATION NEUROPSYCHOLOGY, LLC
Entity type:Organization
Organization Name:NEXT GENERATION NEUROPSYCHOLOGY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST-GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:856-818-6822
Mailing Address - Street 1:2301 E EVESHAM RD STE 206
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4504
Mailing Address - Country:US
Mailing Address - Phone:856-528-5075
Mailing Address - Fax:
Practice Address - Street 1:2301 E EVESHAM RD STE 206
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4504
Practice Address - Country:US
Practice Address - Phone:856-472-6092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1457483349OtherSUSAN EDWARDS