Healthcare Provider Details

I. General information

NPI: 1861858581
Provider Name (Legal Business Name): COTLER CHILDREN AND FAMILY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 09/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11120 S CROWN WAY SUITE 1
WELLINGTON FL
33414-8718
US

IV. Provider business mailing address

11120 S CROWN WAY SUITE 1
WELLINGTON FL
33414-8718
US

V. Phone/Fax

Practice location:
  • Phone: 561-790-1191
  • Fax:
Mailing address:
  • Phone: 561-790-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KERRY M COTLER
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 561-790-1191