Healthcare Provider Details

I. General information

NPI: 1275043796
Provider Name (Legal Business Name): OLGA KOTLER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 E 14TH ST STE 200
BROOKLYN NY
11235-3973
US

IV. Provider business mailing address

2525 WEST ST
BROOKLYN NY
11223-6228
US

V. Phone/Fax

Practice location:
  • Phone: 718-769-2698
  • Fax:
Mailing address:
  • Phone: 347-525-6948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number101858
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: