| Ellen Kotkin Licensed Clinical Social Worker Professional Corp | |
|
16755 Von Karman Ave Ste 200 Irvine CA 92606-4963 | |
| (949) 929-9244 | |
| Not Available |
| Full Name | Ellen Kotkin Licensed Clinical Social Worker Professional Corp |
|---|---|
| Speciality | Social Worker |
| Location | 16755 Von Karman Ave Ste 200, Irvine, California |
| Authorized Official Name and Position | Ellen Kotkin (CEO) |
| Authorized Official Contact | 9499299244 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellen Kotkin Licensed Clinical Social Worker Professional Corp 16755 Von Karman Ave Ste 200 Irvine CA 92606-4963 Ph: (949) 929-9244 | Ellen Kotkin Licensed Clinical Social Worker Professional Corp 16755 Von Karman Ave Ste 200 Irvine CA 92606-4963 Ph: (949) 929-9244 |
| NPI Number | 1992485627 |
|---|---|
| Provider Enumeration Date | 07/18/2023 |
| Last Update Date | 07/24/2023 |
| Certification Date | 07/18/2023 |
| Medicare PECOS PAC ID | 0648624817 |
|---|---|
| Medicare Enrollment ID | O20230922000855 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992485627 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Ellen Kotkin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457780686 PECOS PAC ID: 4486922820 Enrollment ID: I20201211001149 |
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