Provider Demographics
NPI:1306696968
Name:COTTRELL, KEVIN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:COTTRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4721
Mailing Address - Country:US
Mailing Address - Phone:716-908-3350
Mailing Address - Fax:
Practice Address - Street 1:479 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4721
Practice Address - Country:US
Practice Address - Phone:716-908-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health