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General NPI Number Information
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NPI Number | 1063039147
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Entity Type | Individual
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Provider Name | RAE ANN KOTAR NCC, LPC
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Gender | Female
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Dates
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Enumeration Date | 07/06/2020
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 1000 AIRPORT RD STE 205
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5960
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Country | US
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Telephone | 866-625-4740
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 3RD ST
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City | BADEN
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State | PA
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Zip | 15005-1301
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Country | US
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Telephone |
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PC014881
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC014881
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License Number State | PA
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