Provider Demographics
NPI:1124266358
Name:TREML GOTTLIEB, JACQUELINE NOEL (LMSW)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:NOEL
Last Name:TREML GOTTLIEB
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:NOEL
Other - Last Name:TREML
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:904 N TIOGA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3628
Mailing Address - Country:US
Mailing Address - Phone:607-273-7494
Mailing Address - Fax:
Practice Address - Street 1:215 N GENEVA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4166
Practice Address - Country:US
Practice Address - Phone:607-273-7494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical