Provider Demographics
NPI:1073724480
Name:KOTKIN, CECILE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CECILE
Middle Name:
Last Name:KOTKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 BRAGG ST
Mailing Address - Street 2:#509
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1198
Mailing Address - Country:US
Mailing Address - Phone:718-368-1698
Mailing Address - Fax:718-934-5669
Practice Address - Street 1:2790 BRAGG ST
Practice Address - Street 2:#509
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1198
Practice Address - Country:US
Practice Address - Phone:718-368-1698
Practice Address - Fax:718-934-5669
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0274391104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN54292Medicare ID - Type Unspecified
NYN54291Medicare ID - Type Unspecified