Active NPI
Andrea Lee Barrocas Gottlieb, PHD
- Clinical Child & Adolescent Psychologist
- Baltimore, MD
National Provider Identifier
1316239809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 05810
- Practice address
- 6501 N Charles St
Baltimore
Baltimore, MD 21204-6819 - Phone
- (410) 938-3000
- Fax
- (410) 938-5131
- NPI assigned
- May 3, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 05810 | MD | Primary |
Addresses
Primary practice location
6501 N Charles St
Baltimore
Baltimore, MD 21204-6819
Mailing address
6501 N Charles St
Baltimore
Baltimore, MD 21204-6819
Phone (410) 938-3000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2023 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471996800000",
"number": "1316239809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6501 N CHARLES ST",
"address_2": "BALTIMORE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212046819",
"telephone_number": "410-938-3000",
"fax_number": "410-938-5131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6501 N CHARLES ST",
"address_2": "BALTIMORE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212046819",
"telephone_number": "410-938-3000",
"fax_number": "410-938-5131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOTTLIEB",
"first_name": "ANDREA",
"middle_name": "LEE BARROCAS",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-03",
"last_updated": "2016-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MD",
"license": "05810",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.