Basic Information
| Provider Information | |||||||||
| NPI: | 1649504697 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COTTLE | ||||||||
| FirstName: | ELAINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 138 STORMVILLE RD | ||||||||
| Address2: | |||||||||
| City: | HOPEWELL JCT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125336336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 138 STORMVILLE RD | ||||||||
| Address2: | |||||||||
| City: | HOPEWELL JCT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125336336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2009 | ||||||||
| LastUpdateDate: | 08/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 004112-1 | NY | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 225800000X | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Recreation Therapist |
No ID Information.