Healthcare Provider Details

I. General information

NPI: 1518729771
Provider Name (Legal Business Name): COOPER WILLS KOTZAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 ALLEGHANY ST
BOSTON MA
02120-3336
US

IV. Provider business mailing address

214 CEDAR ST
SOMERVILLE MA
02145-3521
US

V. Phone/Fax

Practice location:
  • Phone: 617-733-0226
  • Fax:
Mailing address:
  • Phone: 617-733-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number128937
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: