Provider Demographics
NPI:1366403214
Name:GOTTLIEB, MELANIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-298 UALALEHU ST APT 7
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-4119
Mailing Address - Country:US
Mailing Address - Phone:808-306-5370
Mailing Address - Fax:808-622-4503
Practice Address - Street 1:95-298 UALALEHU ST APT 7
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-4119
Practice Address - Country:US
Practice Address - Phone:808-306-5370
Practice Address - Fax:808-622-4503
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI547103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN