Healthcare Provider Details

I. General information

NPI: 1023195328
Provider Name (Legal Business Name): SELWYN KOTZEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MIDDLETON ST
BROOKLYN NY
11206-5415
US

IV. Provider business mailing address

18 MIDDLETON ST
BROOKLYN NY
11206-5415
US

V. Phone/Fax

Practice location:
  • Phone: 718-875-6900
  • Fax: 718-875-3282
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number063162-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: