Healthcare Provider Details

I. General information

NPI: 1982567624
Provider Name (Legal Business Name): SYDNEY KOTSIRAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 LORING AVE
SALEM MA
01970-4256
US

IV. Provider business mailing address

125 ESSEX ST UNIT 405
SWAMPSCOTT MA
01907-1890
US

V. Phone/Fax

Practice location:
  • Phone: 508-733-7556
  • Fax:
Mailing address:
  • Phone: 508-733-7556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: