Healthcare Provider Details

I. General information

NPI: 1487190427
Provider Name (Legal Business Name): KOTSEN PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2017
Last Update Date: 01/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 SPRING ST
PRINCETON NJ
08542-6904
US

IV. Provider business mailing address

43 SPRING ST
PRINCETON NJ
08542-6904
US

V. Phone/Fax

Practice location:
  • Phone: 609-577-4727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI000354700
License Number StateNJ

VIII. Authorized Official

Name: CHRIS KOTSEN
Title or Position: PSYCHOLOGIST
Credential:
Phone: 609-577-4727