Provider Demographics
NPI:1790956241
Name:GOTTFRIED, MARTI ANN (PC)
Entity Type:Individual
Prefix:
First Name:MARTI
Middle Name:ANN
Last Name:GOTTFRIED
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 DEER RUN CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3248
Mailing Address - Country:US
Mailing Address - Phone:614-891-3942
Mailing Address - Fax:
Practice Address - Street 1:498 DEER RUN CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3248
Practice Address - Country:US
Practice Address - Phone:614-891-3942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0600173101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional