Provider Demographics
NPI:1396924593
Name:KOTTICK, JUDITH (LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:KOTTICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CHRISTOPHER ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4229
Mailing Address - Country:US
Mailing Address - Phone:973-746-7370
Mailing Address - Fax:
Practice Address - Street 1:110 CHRISTOPHER ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4229
Practice Address - Country:US
Practice Address - Phone:973-746-7370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC01516104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker