Provider Demographics
NPI:1194938266
Name:GOTHAM, KATHERINE OBERLE (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:OBERLE
Last Name:GOTHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:BRUNWASSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:105 POSTWOOD PL
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1604
Mailing Address - Country:US
Mailing Address - Phone:734-277-2586
Mailing Address - Fax:
Practice Address - Street 1:1500 21ST AVENUE, ROOM 2272
Practice Address - Street 2:VANDERBILT DEPARTMENT OF PSYCHIATRY OUTPATIENT CLINICS
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-6105
Practice Address - Country:US
Practice Address - Phone:734-761-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3294103TC0700X
MI6301014640103TC0700X
390200000X
TNPSY32942084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program