David Edmund Gottlieb, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Practice address

2024 Hickory Rd.
Ste. 104
Homewood, IL 60430-2125

Phone

(708) 799-8796

Fax

(708) 799-6409

NPI assigned

Oct 3, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1942395306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2024 HICKORY RD.",
            "address_2": "STE. 104",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302125",
            "telephone_number": "708-799-8796",
            "fax_number": "708-799-6409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2024 HICKORY RD.",
            "address_2": "STE. 104",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302125",
            "telephone_number": "708-799-8796",
            "fax_number": "708-799-6409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTTLIEB",
        "first_name": "DAVID",
        "middle_name": "EDMUND",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ID",
            "identifier": "01672899",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Homewood, IL
• Providers in Homewood, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.