Healthcare Provider Details

I. General information

NPI: 1659575652
Provider Name (Legal Business Name): STEVE KOTSAKIS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 HIGHLAND AVENUE
SALEM MA
01970
US

IV. Provider business mailing address

4 COPELAND ROAD
LYNN MA
09102
US

V. Phone/Fax

Practice location:
  • Phone: 781-599-8492
  • Fax:
Mailing address:
  • Phone: 781-599-8492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: