MEDICARE: GOTTLIEB COUNSELING LLC

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1912754029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOTTLIEB COUNSELING LLC

Provider Business Mailing Address
First Line	:	1925 LARK LN
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-2918
Country	:	US
Telephone Number	:	856-375-1076
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 LARK LN
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-2918
Country	:	US
Telephone Number	:	856-375-1076
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MIRIAM GOTTLIEB
Credential	:
Telephone Number	:	856-375-1076

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	05/21/2024

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