Provider Demographics
NPI:1689786998
Name:GOTTFRIED, JANA S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANA
Middle Name:S
Last Name:GOTTFRIED
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:S
Other - Last Name:GOTTFRIED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5000 W SUNSET BLVD
Mailing Address - Street 2:600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5861
Mailing Address - Country:US
Mailing Address - Phone:213-486-4921
Mailing Address - Fax:
Practice Address - Street 1:5000 W SUNSET BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:213-486-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical