Provider Demographics
NPI:1134164999
Name:KOTOWSKI, ALLISON WINFREY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:WINFREY
Last Name:KOTOWSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:L
Other - Last Name:WINFREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9143 PHILIPS HWY
Mailing Address - Street 2:STE 560
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1348
Mailing Address - Country:US
Mailing Address - Phone:904-363-7453
Mailing Address - Fax:904-538-3672
Practice Address - Street 1:2 SHIRCLIFF WAY
Practice Address - Street 2:STE 800
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4732
Practice Address - Country:US
Practice Address - Phone:904-388-2619
Practice Address - Fax:904-388-0240
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 82541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC457ZMedicare PIN
FLP00475430Medicare PIN