MEDICARE: KEVIN LOTZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	076734-1	NY

General Provider Information

NPI Number	:	1386056976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN LOTZ LCSW

Provider Business Mailing Address
First Line	:	311 E 105TH ST APT 3C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-5055
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 3RD AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-2208
Country	:	US
Telephone Number	:	212-400-3230
Fax Number	:	212-360-7454

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2014
Last Update Date	:	05/30/2014

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Directions to “ KEVIN LOTZ LCSW” Practice Location

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