Provider Demographics
NPI:1134428956
Name:KOTTKAMP, LAURA (LICSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KOTTKAMP
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WALDO RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-1723
Mailing Address - Country:US
Mailing Address - Phone:617-785-8785
Mailing Address - Fax:617-232-0078
Practice Address - Street 1:25 WALDO RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-1723
Practice Address - Country:US
Practice Address - Phone:617-785-8785
Practice Address - Fax:617-232-0078
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1191981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical