Provider Demographics
NPI:1386853372
Name:GOTTLIEB, PAULA G (LMFT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:G
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SPENCER PL
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-5601
Mailing Address - Country:US
Mailing Address - Phone:914-777-0500
Mailing Address - Fax:914-667-1224
Practice Address - Street 1:125 SPENCER PL
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-5601
Practice Address - Country:US
Practice Address - Phone:914-777-0500
Practice Address - Fax:914-667-1224
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000216106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist