Provider Demographics
NPI:1447408968
Name:AVA J KOTCH PSY D
Entity Type:Organization
Organization Name:AVA J KOTCH PSY D
Other - Org Name:AVA J KOTCH PSY D
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOTCH
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:1954-557-4883
Mailing Address - Street 1:4302 ALTON ROAD STE: 930
Mailing Address - Street 2:MOUNT SINAI MEDICAL CENTER
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2890
Mailing Address - Country:US
Mailing Address - Phone:954-557-4883
Mailing Address - Fax:305-531-8982
Practice Address - Street 1:4302 ALTON RD STE 930
Practice Address - Street 2:MOUNT SINAI MEDICAL CENTER
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2890
Practice Address - Country:US
Practice Address - Phone:954-557-4883
Practice Address - Fax:305-531-8982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4770103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBI649Medicare UPIN