Healthcare Provider Details

I. General information

NPI: 1639982754
Provider Name (Legal Business Name): AARON KOTTKE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 BAILEY AVE
BUFFALO NY
14215-2814
US

IV. Provider business mailing address

55 DODGE RD
GETZVILLE NY
14068-1205
US

V. Phone/Fax

Practice location:
  • Phone: 716-833-3622
  • Fax: 716-834-4557
Mailing address:
  • Phone: 716-831-2700
  • Fax: 716-831-1818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number126072-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: