Provider Demographics
NPI:1457563850
Name:GOTTLIEB, EILEEN B (M ED)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:B
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 SW 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4421
Mailing Address - Country:US
Mailing Address - Phone:561-278-0246
Mailing Address - Fax:561-243-6838
Practice Address - Street 1:232 SW 28TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4421
Practice Address - Country:US
Practice Address - Phone:561-278-0246
Practice Address - Fax:561-243-6838
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT343106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist