Provider Demographics
NPI:1609266394
Name:JUDITH E. GOTLIEB
Entity Type:Organization
Organization Name:JUDITH E. GOTLIEB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVATE PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-834-1012
Mailing Address - Street 1:62 COBBS MILL RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-3633
Mailing Address - Country:US
Mailing Address - Phone:203-834-1012
Mailing Address - Fax:
Practice Address - Street 1:275 CENTRAL PARK W
Practice Address - Street 2:1W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3015
Practice Address - Country:US
Practice Address - Phone:203-834-1012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002465-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty