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General NPI Number Information
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NPI Number | 1386056976
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Entity Type | Individual
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Provider Name | KEVIN LOTZ LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/30/2014
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Last Update Date | 05/30/2014
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Provider Practice Location Address
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Address Line | 2250 3RD AVE
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City | NEW YORK
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State | NY
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Zip | 10035-2208
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Country | US
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Telephone | 212-400-3230
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Fax | 212-360-7454
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Provider Business Mailing Address
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Address Line | 311 E 105TH ST APT 3C
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City | NEW YORK
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State | NY
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Zip | 10029-5055
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 076734-1
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License Number State | NY
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