Provider Demographics
NPI:1013346295
Name:GOTHELF, ROBYN (LMSW, EDM)
Entity type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:
Last Name:GOTHELF
Suffix:
Gender:F
Credentials:LMSW, EDM
Other - Prefix:MS
Other - First Name:ROBYN
Other - Middle Name:
Other - Last Name:GOTHELF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, EDM
Mailing Address - Street 1:13348 LASALLE BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1029
Mailing Address - Country:US
Mailing Address - Phone:248-677-1697
Mailing Address - Fax:
Practice Address - Street 1:35300 NANKIN BLVD STE 601
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-7222
Practice Address - Country:US
Practice Address - Phone:734-261-1842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801093190104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker