Provider Demographics
NPI:1508104662
Name:GOTTLIEB, ANDREW M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CAMBRIDGE AVE
Mailing Address - Street 2:SUITE 24
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1600
Mailing Address - Country:US
Mailing Address - Phone:650-324-2666
Mailing Address - Fax:
Practice Address - Street 1:415 CAMBRIDGE AVE
Practice Address - Street 2:SUITE 24
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1600
Practice Address - Country:US
Practice Address - Phone:650-324-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9505103T00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral