Individual
CHIE KOTAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
148 WARREN ST, LOWELL, MA 01852-2208
(781) 572-8253
Mailing address
8 CROWNINSHIELD ST, UNIT 111, PEABODY, MA 01960-8201
(781) 572-8253
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Enumeration date
08/02/2012
Last updated
08/02/2012
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