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General NPI Number Information
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NPI Number | 1306192802
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Entity Type | Individual
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Provider Name | CHIE KOTAKE M.A.
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Gender | Female
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | 148 WARREN ST
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City | LOWELL
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State | MA
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Zip | 01852-2208
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Country | US
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Telephone | 781-572-8253
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Fax |
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Provider Business Mailing Address
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Address Line | 8 CROWNINSHIELD ST UNIT 111
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City | PEABODY
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State | MA
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Zip | 01960-8201
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Country | US
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Telephone | 781-572-8253
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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