Provider Demographics
NPI:1225655137
Name:GOTTLIEB, LAURA DISKIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:DISKIN
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 CONNECTICUT AVE NW STE 300
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-5700
Mailing Address - Country:US
Mailing Address - Phone:202-540-8113
Mailing Address - Fax:
Practice Address - Street 1:1801 CONNECTICUT AVE NW STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-5700
Practice Address - Country:US
Practice Address - Phone:202-540-8113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06409103TC0700X
VA0810006911103TC0700X
DCPSY1001635103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical