Provider Demographics
NPI:1891308904
Name:SUSAN GOTTLIEB PHD LLC
Entity Type:Organization
Organization Name:SUSAN GOTTLIEB PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-408-3074
Mailing Address - Street 1:PO BOX 250621
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-0621
Mailing Address - Country:US
Mailing Address - Phone:248-408-3074
Mailing Address - Fax:
Practice Address - Street 1:23800 ORCHARD LAKE RD STE 104
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2561
Practice Address - Country:US
Practice Address - Phone:248-408-3074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty