| Doctor Name: | MRS. BONNIE F KOTKIN |
| NPI Number: | 1124469150 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LMHC |
| License Number: | 005520 |
| Business Practice Address: | 475 E Main St Suite 200 Patchogue, NY - 117723121 |
| Business Phone Number: | 5169096850 |
| Business Fax Number: | |
| Mailing Address: | 85 Old Brook Rd, DIX HILLS |
| State: | NY |
| Postal Code: | 117466429 |
| Phone Number: | 5169096850 |
| Fax Number: | |
| NPI Enumeration Date: | 07/06/2013 |
| NPI Last Update Date: | 07/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 005520 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |