Provider Demographics
NPI:1194865675
Name:KOTHARI, ERIC VIPIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:VIPIN
Last Name:KOTHARI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 THIRD STREET
Mailing Address - Street 2:PSYCHOTHERAPYWORKS
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170
Mailing Address - Country:US
Mailing Address - Phone:703-787-8064
Mailing Address - Fax:703-787-8065
Practice Address - Street 1:800 THIRD STREET
Practice Address - Street 2:PSYCHOTHERAPYWORKS
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170
Practice Address - Country:US
Practice Address - Phone:703-787-8064
Practice Address - Fax:703-787-8065
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA08010003698103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical