Provider Demographics
NPI:1134230733
Name:GOERTZEL, LILLIAN S (EDD)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:S
Last Name:GOERTZEL
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:S
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 E STRATFORD AVE
Mailing Address - Street 2:STE 1A
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050
Mailing Address - Country:US
Mailing Address - Phone:610-622-0965
Mailing Address - Fax:610-771-0372
Practice Address - Street 1:14 E STRATFORD AVE
Practice Address - Street 2:STE 1A
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050
Practice Address - Country:US
Practice Address - Phone:610-622-0965
Practice Address - Fax:610-771-0372
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006120L103TC0700X
NJS103107103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical