Provider Demographics
NPI:1194494799
Name:LOTSOS, KATHERYN
Entity type:Individual
Prefix:
First Name:KATHERYN
Middle Name:
Last Name:LOTSOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HART PL
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3923
Mailing Address - Country:US
Mailing Address - Phone:908-358-3088
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 1815
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1118
Practice Address - Country:US
Practice Address - Phone:908-358-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0763341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical