Provider Demographics
NPI:1174244610
Name:E.M. GOTTHARDT, LCSW, PLLC
Entity type:Organization
Organization Name:E.M. GOTTHARDT, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GOTTHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:607-238-3459
Mailing Address - Street 1:PO BOX 504
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:NY
Mailing Address - Zip Code:13783-0504
Mailing Address - Country:US
Mailing Address - Phone:607-238-3459
Mailing Address - Fax:
Practice Address - Street 1:71 RISLEY ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:NY
Practice Address - Zip Code:13783-1011
Practice Address - Country:US
Practice Address - Phone:607-238-3459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1134550957Medicaid