Healthcare Provider Details

I. General information

NPI: 1669574836
Provider Name (Legal Business Name): BARRY M KOTEL LCSW PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 RIVERSIDE DR SUITE 1A
NEW YORK NY
10024-3726
US

IV. Provider business mailing address

125 RIVERSIDE DR SUITE 1A
NEW YORK NY
10024-3726
US

V. Phone/Fax

Practice location:
  • Phone: 212-874-0605
  • Fax: 212-874-0605
Mailing address:
  • Phone: 212-874-0605
  • Fax: 212-874-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR0135291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: