Provider Demographics
NPI:1205929924
Name:GOTTESMAN, DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:GOTTESMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE WASHINGTON STREET
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481
Mailing Address - Country:US
Mailing Address - Phone:877-499-2625
Mailing Address - Fax:617-244-3480
Practice Address - Street 1:ONE WASHINGTON STREET
Practice Address - Street 2:SUITE 305
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481
Practice Address - Country:US
Practice Address - Phone:877-499-2625
Practice Address - Fax:617-244-3480
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2727103TC0700X
RIPS00678103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO2820OtherBLUE CROSS/BLUE SHIELD MA
MA020064OtherVALUE-OPTIONS