Provider Demographics
NPI:1982789970
Name:KOTKIN, LAWRENCE ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ROBERT
Last Name:KOTKIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 WILMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4032
Mailing Address - Country:US
Mailing Address - Phone:631-643-0924
Mailing Address - Fax:631-491-9110
Practice Address - Street 1:61 WILMINGTON DR
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4032
Practice Address - Country:US
Practice Address - Phone:631-643-0924
Practice Address - Fax:631-491-9110
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6339103TB0200X, 103TC0700X, 103TF0000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY87726OtherUNITED BEHAVIORAL HEALTH
NY087600OtherVALUE OPTIONS
NY35296OtherVYTRA BEHAVIORAL HEALTH
NYAS217OtherOXFORD HEALTH PLANS
NY104024000OtherMAGELLAN HEALTH PLANS
NY35296OtherVYTRA BEHAVIORAL HEALTH