Provider Demographics
NPI:1720659576
Name:GOLDNER, JILL TERESE (LPC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:TERESE
Last Name:GOLDNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1519
Mailing Address - Country:US
Mailing Address - Phone:484-264-5968
Mailing Address - Fax:
Practice Address - Street 1:666 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-1519
Practice Address - Country:US
Practice Address - Phone:484-264-5968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00546400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health