Healthcare Provider Details

I. General information

NPI: 1669970257
Provider Name (Legal Business Name): JULIE KOTRAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 EGG HARBOR RD STE B
SEWELL NJ
08080-1856
US

IV. Provider business mailing address

709 QUEST CT
MANTUA NJ
08051-2277
US

V. Phone/Fax

Practice location:
  • Phone: 856-589-3420
  • Fax: 856-345-2820
Mailing address:
  • Phone: 856-325-9134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC0574800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05748000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: