Provider Demographics
NPI:1457722621
Name:GOTTLIEB-COHEN, ANDREW (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:GOTTLIEB-COHEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1186 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1627
Mailing Address - Country:US
Mailing Address - Phone:781-864-1533
Mailing Address - Fax:
Practice Address - Street 1:40 TEMPLE ST STE 7C
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2715
Practice Address - Country:US
Practice Address - Phone:203-785-2513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT107151041C0700X
CAASW73599104100000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker