Provider Demographics
NPI:1558382044
Name:GOTTLIEB, WERNER (MSW,LCSW)
Entity Type:Individual
Prefix:MR
First Name:WERNER
Middle Name:
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 COLONIAL CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1125
Mailing Address - Country:US
Mailing Address - Phone:925-946-1603
Mailing Address - Fax:925-937-8303
Practice Address - Street 1:37 QUAIL CT
Practice Address - Street 2:101
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5592
Practice Address - Country:US
Practice Address - Phone:925-946-1603
Practice Address - Fax:925-937-8303
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS9434101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health