Provider Demographics
NPI:1912220914
Name:GOTTFRIED, SARAH MARIE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:GOTTFRIED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N BROOM ST FL 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-5216
Mailing Address - Country:US
Mailing Address - Phone:608-301-5708
Mailing Address - Fax:608-729-3434
Practice Address - Street 1:301 N BROOM ST FL 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-5216
Practice Address - Country:US
Practice Address - Phone:608-301-5708
Practice Address - Fax:608-729-3434
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6284-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional