Healthcare Provider Details

I. General information

NPI: 1255469573
Provider Name (Legal Business Name): RICHARD F. GOTTLIEB M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 FULTON ST E STE 222
GRAND RAPIDS MI
49503-3262
US

IV. Provider business mailing address

233 FULTON ST E STE 222
GRAND RAPIDS MI
49503-3262
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-9000
  • Fax:
Mailing address:
  • Phone: 616-774-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801008932
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101005165
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number6801008932
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: