Healthcare Provider Details

I. General information

NPI: 1316126311
Provider Name (Legal Business Name): LINDA L KOTASEK BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HAWLEY ST
BINGHAMTON NY
13901-3102
US

IV. Provider business mailing address

1708 JUNEBERRY CT
VESTAL NY
13850-3328
US

V. Phone/Fax

Practice location:
  • Phone: 607-778-1145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: