Provider Demographics
NPI:1194838011
Name:GOTTLIEB, LINDA JOY (LCSW, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JOY
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FOLGER LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5805
Mailing Address - Country:US
Mailing Address - Phone:631-673-6665
Mailing Address - Fax:
Practice Address - Street 1:8 FOLGER LN
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5805
Practice Address - Country:US
Practice Address - Phone:631-673-6665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R02472511041C0700X
NY000255106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01650146Medicaid
NY01650146Medicaid