Provider Demographics
NPI:1962256263
Name:KOTKIN, EVE MICHELLE
Entity type:Individual
Prefix:MS
First Name:EVE
Middle Name:MICHELLE
Last Name:KOTKIN
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 1:109 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1875
Mailing Address - Country:US
Mailing Address - Phone:201-741-7985
Mailing Address - Fax:
Practice Address - Street 1:220 KINDERKAMACK RD STE C2
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3601
Practice Address - Country:US
Practice Address - Phone:201-308-3921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00387000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional