Provider Demographics
NPI:1730538190
Name:MEYERSON KOTLIAR, AMY (LCSW, ACHP-SW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MEYERSON KOTLIAR
Suffix:
Gender:F
Credentials:LCSW, ACHP-SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-0022
Mailing Address - Country:US
Mailing Address - Phone:201-370-5131
Mailing Address - Fax:
Practice Address - Street 1:999 RICHARD CT
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5511
Practice Address - Country:US
Practice Address - Phone:201-370-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056816001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC05681600OtherLCSW