Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | ||
Y | 103TC0700X | Clinical Psychologist | ||
N | 103G00000X | Clinical Psychologist | 35SI00589700 | NJ |
N | 103TC0700X | Clinical Psychologist | 35SI00589700 | NJ |
N | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1063913176 |
---|---|
Provider Name | Dr. Jennifer West-Gavin |
First Address | Voorhees, NJ 08043-4504 |
Second Address | Voorhees, NJ 08043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2018 |
Last Update Date | 07/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063913176 | HORIZON (01) |