Provider Demographics
NPI:1245418805
Name:GOTTESMANN RUBIN, SHERRY (LCSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:
Last Name:GOTTESMANN RUBIN
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:MS
Other - First Name:SHERRY
Other - Middle Name:
Other - Last Name:GOTTESMANN RUBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, BCD
Mailing Address - Street 1:50 W WELSH POOL RD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1200
Mailing Address - Country:US
Mailing Address - Phone:610-873-0815
Mailing Address - Fax:
Practice Address - Street 1:50 W WELSH POOL RD
Practice Address - Street 2:SUITE #4
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1200
Practice Address - Country:US
Practice Address - Phone:610-873-0815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW004170L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical