Healthcare Provider Details

I. General information

NPI: 1639595812
Provider Name (Legal Business Name): JOHN DAVID KOTLER LCSW-C, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5480 WISCONSIN AVE STE 227
CHEVY CHASE MD
20815-3500
US

IV. Provider business mailing address

4403 GLENRIDGE ST
KENSINGTON MD
20895-4214
US

V. Phone/Fax

Practice location:
  • Phone: 301-785-9490
  • Fax:
Mailing address:
  • Phone: 301-785-9490
  • Fax: 301-785-9490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50082094
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19217
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: