MEDICARE: ELISHEVA GOTTSTEIN PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6669	NC
2	103TC0700X	Clinical Psychologist	0810008489	VA

General Provider Information

NPI Number	:	1235975582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISHEVA GOTTSTEIN PSYD

Provider Business Mailing Address
First Line	:	1003 MIRBECK LN
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-2569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 MIRBECK LN
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-2569
Country	:	US
Telephone Number	:	907-223-3718
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2024
Last Update Date	:	06/09/2026

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