Provider Demographics
NPI:1669574836
Name:KOTEL, BARRY M (LCSW PC)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:M
Last Name:KOTEL
Suffix:
Gender:M
Credentials:LCSW PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 RIVERSIDE DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3726
Mailing Address - Country:US
Mailing Address - Phone:212-874-0605
Mailing Address - Fax:212-874-0605
Practice Address - Street 1:125 RIVERSIDE DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3726
Practice Address - Country:US
Practice Address - Phone:212-874-0605
Practice Address - Fax:212-874-0605
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR01352911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02031670Medicaid
NY02031670Medicaid