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General NPI Number Information
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NPI Number | 1134699077
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Entity Type | Individual
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Provider Name | JUDY PAULA KOTZEN M.S.W.
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Gender | Female
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Dates
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Enumeration Date | 12/04/2018
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 13309 LASALLE
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1031
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Country | US
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Telephone | 248-376-1138
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Fax |
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Provider Business Mailing Address
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Address Line | 13309 LASALLE
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1031
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801064971
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801064971
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License Number State | MI
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