Provider Demographics
NPI:1245295005
Name:MINOTTI, KATHLEEN M (LCSWR)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:M
Last Name:MINOTTI
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-1831
Mailing Address - Country:US
Mailing Address - Phone:607-734-1447
Mailing Address - Fax:607-737-6274
Practice Address - Street 1:963 WALNUT ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-1831
Practice Address - Country:US
Practice Address - Phone:607-734-1447
Practice Address - Fax:607-737-6274
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03524111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53690DMedicare PIN