Provider Demographics
NPI:1942594916
Name:GOTTLIEB, JULIA MAE (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MAE
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 EARP ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-5904
Mailing Address - Country:US
Mailing Address - Phone:717-648-0012
Mailing Address - Fax:
Practice Address - Street 1:525 S 4TH ST
Practice Address - Street 2:SUITE 240B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1570
Practice Address - Country:US
Practice Address - Phone:484-362-9792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0180791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical