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General NPI Number Information
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NPI Number | 1508256397
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Entity Type | Organization
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Legal Business Name | JUDITH E. GOTLIEB, LMFT
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Dates
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Enumeration Date | 01/31/2015
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 62 COBBS MILL RD
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City | WILTON
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State | CT
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Zip | 06897-3633
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Country | US
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Telephone | 203-834-1012
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Fax |
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Provider Business Mailing Address
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Address Line | 62 COBBS MILL RD
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City | WILTON
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State | CT
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Zip | 06897-3633
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Country | US
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Telephone | 203-834-1012
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Fax |
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Authorized Official
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Title or Position | PRIVATE PRACTICE
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Name | JUDITH GOTLIEB
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Credential | LMFT
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Telephone | 203-834-1012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001487
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License Number State | CT
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