Provider Demographics
NPI:1538612551
Name:GOTTFRIED, EMILY (PHD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:GOTTFRIED
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:29 LEINBACH DR
Practice Address - Street 2:SUITE C MUSC
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7071
Practice Address - Country:US
Practice Address - Phone:843-792-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1353103TC0700X
GAPSY003928103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical