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NPI Code Detail

MEDICARE: DR. DIANE T GOTTLIEB MSW, PH.D.

MEDICARE: DR. DIANE T GOTTLIEB MSW, PH.D.
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
1103TC0700XClinical Psychologist478VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1011764OTHERVTTRICARE VALUE OPTIONS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3T000511OTHERVTCHAMPUS TRICARE
401260007OTHERMAMAGELLEN MASS
5108058OTHERVTUNITED BEHAVIORAL HEALTH
6223960OTHERVTCOMPSYCH
764071OTHERVTCIGNA
88064OTHERVTBC AND BS

General Provider Information

NPI Number : 1982775763
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANE T GOTTLIEB MSW, PH.D.
Provider Business Mailing Address
First Line : 187 SAINT PAUL ST
Second Line : SUITE 2
City : BURLINGTON
State : VT
Zip : 05401-4689
Country : US
Telephone Number : 802-863-2495
Fax Number : 802-865-0534
Provider Business Practice Location Address
First Line : 187 SAINT PAUL ST
Second Line : SUITE 2
City : BURLINGTON
State : VT
Zip : 05401-4689
Country : US
Telephone Number : 802-863-2495
Fax Number : 802-865-0534
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2006
Last Update Date : 07/09/2007

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