Healthcare Provider Details

I. General information

NPI: 1841429180
Provider Name (Legal Business Name): STEFANIE ALYSE KOTZEN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 DURHAM CHAPEL HILL BLVD
DURHAM NC
27707-2829
US

IV. Provider business mailing address

2670 DURHAM CHAPEL HILL BLVD
DURHAM NC
27707-2829
US

V. Phone/Fax

Practice location:
  • Phone: 919-251-9001
  • Fax: 919-251-9008
Mailing address:
  • Phone: 919-251-9001
  • Fax: 919-251-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC006962
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: