Healthcare Provider Details

I. General information

NPI: 1740356575
Provider Name (Legal Business Name): ANNA MARIE KOTSEN MARRIAGE AND FAMILY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ANNA MARIE CIRACI

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 BEAVER BROOK RD SUITE 303D
LINCOLN PARK NJ
07035
US

IV. Provider business mailing address

1823 MILL CREEK RD
MANAHAWKIN NJ
08050
US

V. Phone/Fax

Practice location:
  • Phone: 609-978-2860
  • Fax:
Mailing address:
  • Phone: 609-978-2860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37F100144700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: