Provider Demographics
NPI:1720387590
Name:KOTSIOS, SPIRO (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:SPIRO
Middle Name:
Last Name:KOTSIOS
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 BAHIA DEL MAR CIRCLE
Mailing Address - Street 2:UNIT 508
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33715
Mailing Address - Country:US
Mailing Address - Phone:727-278-1171
Mailing Address - Fax:
Practice Address - Street 1:5701 BAHIA DEL MAR CIR
Practice Address - Street 2:UNIT 508
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33715-2394
Practice Address - Country:US
Practice Address - Phone:727-278-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-19
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-15-18495103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010671700Medicaid