MEDICARE: HEATHER ANNE COCHRAN MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	96856	CA

General Provider Information

NPI Number	:	1194004135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER ANNE COCHRAN MSW

Provider Business Mailing Address
First Line	:	4120 BIRCH ST STE 121
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2228
Country	:	US
Telephone Number	:	415-755-8169
Fax Number	:

Provider Business Practice Location Address
First Line	:	29833 SANTA MARGARITA PKWY STE 400
Second Line	:
City	:	RANCHO SANTA MARGARITA
State	:	CA
Zip	:	92688-3619
Country	:	US
Telephone Number	:	415-755-8169
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	02/06/2023

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