Provider Demographics
NPI:1487615944
Name:KOETTING, MICHAEL E (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:KOETTING
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
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Mailing Address - Street 1:1 W 64TH ST
Mailing Address - Street 2:SUITE 11D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6734
Mailing Address - Country:US
Mailing Address - Phone:212-877-6523
Mailing Address - Fax:212-741-2606
Practice Address - Street 1:49 W 24TH ST
Practice Address - Street 2:SUITE 906
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3206
Practice Address - Country:US
Practice Address - Phone:212-741-2606
Practice Address - Fax:212-741-2606
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYR0494501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN1H95OtherEMPIRE BLUE CROSS
NYP1316096OtherOXFORD HEALTH PLANS
NY01947786Medicaid
NY337512OtherVALUE OPTIONS
NY7407501OtherGROUP HEALTH INCORPORATED
NYKM9450OtherATLANTIS HEALTH PLAN
NYKM9450OtherATLANTIS HEALTH PLAN