Provider Demographics
NPI:1083965420
Name:GOTTFRIED, ADAM TODD (LMSW)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:TODD
Last Name:GOTTFRIED
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 OLD WESTBURY RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2215
Mailing Address - Country:US
Mailing Address - Phone:516-626-1971
Mailing Address - Fax:516-626-8043
Practice Address - Street 1:480 OLD WESTBURY RD
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2215
Practice Address - Country:US
Practice Address - Phone:516-626-1971
Practice Address - Fax:516-626-8043
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082104104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker