Provider Demographics
NPI:1942637145
Name:GOTTESMAN, MELINDA (PSYD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:GOTTESMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 GOUGH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4474
Mailing Address - Country:US
Mailing Address - Phone:415-855-3817
Mailing Address - Fax:
Practice Address - Street 1:414 GOUGH ST STE 4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4474
Practice Address - Country:US
Practice Address - Phone:415-855-3817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2023-06-05
Deactivation Date:2019-11-20
Deactivation Code:
Reactivation Date:2020-11-20
Provider Licenses
StateLicense IDTaxonomies
CAPSY32007103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical