Provider Demographics
NPI:1902373509
Name:BRIDGET GOTTLIEB, LMSW, L.L.C.
Entity Type:Organization
Organization Name:BRIDGET GOTTLIEB, LMSW, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER/CLINICAL
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-560-6701
Mailing Address - Street 1:14077 FOX TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1249
Mailing Address - Country:US
Mailing Address - Phone:616-560-6701
Mailing Address - Fax:
Practice Address - Street 1:461 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1508
Practice Address - Country:US
Practice Address - Phone:616-560-6701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty