Healthcare Provider Details

I. General information

NPI: 1003110230
Provider Name (Legal Business Name): DAVID KOTARSKY PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25700 SCIENCE PARK DR STE 200
BEACHWOOD OH
44122-7328
US

IV. Provider business mailing address

PO BOX 96
MC CLELLANDTOWN PA
15458-0096
US

V. Phone/Fax

Practice location:
  • Phone: 216-831-1040
  • Fax: 216-831-2667
Mailing address:
  • Phone: 412-582-6296
  • Fax: 855-737-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6726
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: