Provider Demographics
NPI:1417105636
Name:COTTLE, KENNETH AUSTIN (LMSW)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:AUSTIN
Last Name:COTTLE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BRADY RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-3846
Mailing Address - Country:US
Mailing Address - Phone:845-986-9439
Mailing Address - Fax:
Practice Address - Street 1:16-24 UNION STREET
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-343-5556
Practice Address - Fax:845-343-3341
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0835301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical