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NPI Code Detail

MEDICARE: MS. ELLEN GOTTLICH LCSW

MEDICARE: MS. ELLEN GOTTLICH LCSW
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
11041C0700XClinical Social Worker44SC00039300NJ

General Provider Information

NPI Number : 1932294790
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELLEN GOTTLICH LCSW
Provider Business Mailing Address
First Line : 665 E LAKE FRONT CIR
Second Line :
City : GALLOWAY
State : NJ
Zip : 08205-3314
Country : US
Telephone Number : 609-652-8809
Fax Number :
Provider Business Practice Location Address
First Line : 600 NEW RD
Second Line :
City : NORTHFIELD
State : NJ
Zip : 08225-1653
Country : US
Telephone Number : 609-641-2500
Fax Number : 609-641-2502
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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Directions to “ MS. ELLEN GOTTLICH LCSW” Practice Location

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