Healthcare Provider Details

I. General information

NPI: 1295999787
Provider Name (Legal Business Name): CHRIS SAMUEL KOTSEN PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 3RD AVE FL 4
NEW YORK NY
10017-6943
US

IV. Provider business mailing address

633 3RD AVE FL 4
NEW YORK NY
10017-6943
US

V. Phone/Fax

Practice location:
  • Phone: 646-888-0042
  • Fax: 212-888-2584
Mailing address:
  • Phone: 646-888-0042
  • Fax: 212-888-2584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3547
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: