Provider Demographics
NPI:1699079426
Name:GOSTERISLI, EMILY CATHERINE (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:CATHERINE
Last Name:GOSTERISLI
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 HOSEA WILLIAMS DR SE STE 2
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-2501
Mailing Address - Country:US
Mailing Address - Phone:404-445-5145
Mailing Address - Fax:
Practice Address - Street 1:2033 HOSEA WILLIAMS DR SE STE 2
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-2501
Practice Address - Country:US
Practice Address - Phone:404-445-5145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-09
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0041911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical