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General NPI Number Information
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NPI Number | 1003110230
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Entity Type | Individual
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Provider Name | DAVID KOTARSKY PH.D
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Gender | Male
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Dates
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Enumeration Date | 01/03/2011
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 25700 SCIENCE PARK DR STE 200
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City | BEACHWOOD
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State | OH
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Zip | 44122-7328
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Country | US
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Telephone | 216-831-1040
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Fax | 216-831-2667
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Provider Business Mailing Address
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Address Line | PO BOX 96
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City | MC CLELLANDTOWN
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State | PA
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Zip | 15458-0096
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Country | US
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Telephone | 412-582-6296
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Fax | 855-737-2544
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6726
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License Number State | OH
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