Provider Demographics
NPI:1104965946
Name:GOTTA, HOLLY WHITE (LCSW)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:WHITE
Last Name:GOTTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HAYES HILL DR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1331
Mailing Address - Country:US
Mailing Address - Phone:631-261-8873
Mailing Address - Fax:631-261-8873
Practice Address - Street 1:25 HAYES HILL DR
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1331
Practice Address - Country:US
Practice Address - Phone:631-261-8873
Practice Address - Fax:631-261-8873
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO18166-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical