Bryan Gottlieb, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS019290 Issued in PA

Practice address

964 Isabel Dr
Lebanon, PA 17042-7482

Phone

(717) 274-9777

Fax

(717) 274-9815

NPI assigned

Jul 9, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Optum Behavioral Care of Connecticut PCGroup PAC ID 9436502879, 132 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bryan.gottlieb.1@28623.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Optum Behavioral Care of Connecticut, P.C.

  • Counseling Psychologist
  • Philadelphia, PA
  • NPI 1811778988
  Medicare reassignment Care Compare group NPD
• Springfield Psychological PC

  • Mental Health Counselor
  • Springfield, PA
  • NPI 1295705317
  NPD
• Optum Behavioral Care of Connecticut, P.C.

  • Clinical Social Worker
  • Providence, RI
  • NPI 1730972944
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1043881063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "785 5TH AVE STE 3",
            "city": "CHAMBERSBURG",
            "state": "PA",
            "postal_code": "172014232",
            "telephone_number": "717-263-9555",
            "fax_number": "717-709-6529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "964 ISABEL DR",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427482",
            "telephone_number": "717-274-9777",
            "fax_number": "717-274-9815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTTLIEB",
        "first_name": "BRYAN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-09",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS019290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "15372983",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PS019290",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103933713",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandy Goodstein, PA/C
• Julie A Gordon-Dueck, PHD
• Kevin Gordon, PA-C
• Katie I Gorey, LCSW
• Apryl Gorton
• Dominic Gould, MA, LPC
• Brooke Graby
• Graceful Hands Home Care and Transport Services LLC
• Robert Gradzki, M.D.
• Kenneth Walter Graf, MD

• Clinical Psychologist in Lebanon, PA
• Providers in Lebanon, PA by specialty
• Clinical Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.