Provider Demographics
NPI:1811140965
Name:KOTKIN, MARSHA ELAINE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:ELAINE
Last Name:KOTKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22584 CARAVELLE CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5924
Mailing Address - Country:US
Mailing Address - Phone:561-488-5645
Mailing Address - Fax:
Practice Address - Street 1:22584 CARAVELLE CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5924
Practice Address - Country:US
Practice Address - Phone:561-488-5645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7779103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical