Provider Demographics
NPI:1700315645
Name:GOTTESFELD, IRMA NANN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:IRMA
Middle Name:NANN
Last Name:GOTTESFELD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WEST 72ND ST.
Mailing Address - Street 2:SUITE 5E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:212-787-9284
Mailing Address - Fax:
Practice Address - Street 1:117 WEST 72ND ST.
Practice Address - Street 2:SUITE 5E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-787-9284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15321-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical