Healthcare Provider Details

I. General information

NPI: 1487203758
Provider Name (Legal Business Name): DEVORAH KOTZEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 02/21/2023
Certification Date: 09/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 MAYFIELD RD STE 306
LYNDHURST OH
44124-2697
US

IV. Provider business mailing address

5309 18TH AVE
BROOKLYN NY
11204-1523
US

V. Phone/Fax

Practice location:
  • Phone: 216-591-6191
  • Fax:
Mailing address:
  • Phone: 718-705-5190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: