Provider Demographics
NPI:1093741621
Name:BELL, LEAH KOTLER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:KOTLER
Last Name:BELL
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 1:435 BUCKLAND RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3720
Mailing Address - Country:US
Mailing Address - Phone:860-453-0031
Mailing Address - Fax:
Practice Address - Street 1:100 WEST RD
Practice Address - Street 2:SUITE 3
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-3798
Practice Address - Country:US
Practice Address - Phone:860-454-0520
Practice Address - Fax:860-454-8469
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002779104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
304295OtherMHN
CT8172610OtherAETNA
134072OtherVALUE OPTIONS
CT140002779CT10OtherBCBS
P3096179OtherOXFORD
98229OtherCIGNA
CT800003195Medicare ID - Type Unspecified
CT8172610OtherAETNA