Provider Demographics
NPI:1396581906
Name:GOTTESMAN, MIREL (BCBA)
Entity type:Individual
Prefix:
First Name:MIREL
Middle Name:
Last Name:GOTTESMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3038
Mailing Address - Country:US
Mailing Address - Phone:732-239-1157
Mailing Address - Fax:
Practice Address - Street 1:845 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3038
Practice Address - Country:US
Practice Address - Phone:732-239-1157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst