Basic Information
| Provider Information | |||||||||
| NPI: | 1770032294 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BREIER GOTTLIEB | ||||||||
| FirstName: | ROBIN | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 N CENTRAL AVE | ||||||||
| Address2: | C/O WJCS | ||||||||
| City: | HARTSDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105301912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149497699 | ||||||||
| FaxNumber: | 9149493224 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 W PROSPECT AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105502017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146688938 | ||||||||
| FaxNumber: | 9146682545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2016 | ||||||||
| LastUpdateDate: | 05/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 091191 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.