Provider Demographics
NPI:1861858581
Name:COTLER CHILDREN AND FAMILY SERVICES, LLC
Entity Type:Organization
Organization Name:COTLER CHILDREN AND FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:COTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-790-1191
Mailing Address - Street 1:11120 S CROWN WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8718
Mailing Address - Country:US
Mailing Address - Phone:561-790-1191
Mailing Address - Fax:
Practice Address - Street 1:11120 S CROWN WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8718
Practice Address - Country:US
Practice Address - Phone:561-790-1191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016640000Medicaid
FL017326800Medicaid