Provider Demographics
NPI:1174648695
Name:KOTLER, CAROLE J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:J
Last Name:KOTLER
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 1:57 BLANCHE ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4621
Mailing Address - Country:US
Mailing Address - Phone:516-938-8137
Mailing Address - Fax:
Practice Address - Street 1:57 BLANCHE ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4621
Practice Address - Country:US
Practice Address - Phone:516-938-8137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041475-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN9L501Medicare ID - Type Unspecified