Healthcare Provider Details

I. General information

NPI: 1134164999
Provider Name (Legal Business Name): ALLISON WINFREY KOTOWSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON L WINFREY LCSW

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SHIRCLIFF WAY STE 800
JACKSONVILLE FL
32204-4732
US

IV. Provider business mailing address

9143 PHILIPS HWY STE 560
JACKSONVILLE FL
32256-1348
US

V. Phone/Fax

Practice location:
  • Phone: 904-388-2619
  • Fax: 904-388-0240
Mailing address:
  • Phone: 904-363-7453
  • Fax: 904-538-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 8254
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: