Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801008932 | MI |
N | 225C00000X | Rehabilitation Counselor | 6801008932 | MI |
NPI | 1255469573 |
---|---|
Provider Name | Richard F. Gottlieb |
First Address | Grand Rapids, MI 49503-3262 |
Second Address | Grand Rapids, MI 49503-3262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 08/08/2008 |