Provider Demographics
NPI:1316239809
Name:GOTTLIEB, ANDREA LEE BARROCAS (PHD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEE BARROCAS
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6501 N CHARLES ST
Mailing Address - Street 2:BALTIMORE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6819
Mailing Address - Country:US
Mailing Address - Phone:410-938-3000
Mailing Address - Fax:410-938-5131
Practice Address - Street 1:6501 N CHARLES ST
Practice Address - Street 2:BALTIMORE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6819
Practice Address - Country:US
Practice Address - Phone:410-938-3000
Practice Address - Fax:410-938-5131
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05810103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent