Provider Demographics
NPI:1346352481
Name:ALEXANDER-GOTTESMAN, JILL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:ALEXANDER-GOTTESMAN
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 1:1357 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2503
Mailing Address - Country:US
Mailing Address - Phone:814-455-1544
Mailing Address - Fax:
Practice Address - Street 1:1357 W 6TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-2503
Practice Address - Country:US
Practice Address - Phone:814-455-1544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007709L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102596950Medicaid
PA604255OtherHIGHMARK BLUE CROSS /SHIE
PA1025969500001Medicaid
PA102596950Medicaid