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General NPI Number Information
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NPI Number | 1902373509
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Entity Type | Organization
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Legal Business Name | BRIDGET GOTTLIEB, LMSW, L.L.C.
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Dates
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Enumeration Date | 11/01/2018
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Last Update Date | 11/01/2018
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Provider Practice Location Address
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Address Line | 461 CANTERBURY DR
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City | SALINE
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State | MI
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Zip | 48176-1508
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Country | US
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Telephone | 616-560-6701
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Fax |
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Provider Business Mailing Address
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Address Line | 14077 FOX TRAIL DR
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City | HOLLAND
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State | MI
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Zip | 49424-1249
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Country | US
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Telephone | 616-560-6701
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER/CLINICAL
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Name | BRIDGET GOTTLIEB
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Credential | LMSW
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Telephone | 616-560-6701
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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 |
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License Number State |
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