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NPI Code Detail

MEDICARE: JILL LYNN GOTTLIEB L.C.S.W.

MEDICARE: JILL LYNN GOTTLIEB L.C.S.W.
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
1101YM0800XMental Health CounselorCSW09924200CO
21041C0700XClinical Social WorkerLCS 14338CA

General Provider Information

NPI Number : 1811085467
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL LYNN GOTTLIEB L.C.S.W.
Provider Business Mailing Address
First Line : 3303 N BROADWAY FL 4
Second Line :
City : LOS ANGELES
State : CA
Zip : 90031-2803
Country : US
Telephone Number : 213-325-4984
Fax Number :
Provider Business Practice Location Address
First Line : 3303 N BROADWAY FL 4
Second Line :
City : LOS ANGELES
State : CA
Zip : 90031-2803
Country : US
Telephone Number : 213-325-4984
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 08/08/2022

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