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General NPI Number Information
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NPI Number | 1356613111
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Entity Type | Individual
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Provider Name | LISA BROOKE GOTTESMAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 104 MEWS LN
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City | CHERRY HILL
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State | NJ
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Zip | 08003-2629
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Country | US
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Telephone | 609-529-3439
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Fax | 267-285-4336
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Provider Business Mailing Address
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Address Line | PO BOX 3143
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City | CHERRY HILL
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State | NJ
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Zip | 08034-0293
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Country | US
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Telephone | 267-825-7458
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW017227
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License Number State | PA
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