MEDICARE: KATHERINE DEJOY COSSETTE LCSW

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1205036381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE DEJOY COSSETTE LCSW

Provider Business Mailing Address
First Line	:	1685 FRAZIER PARK DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-1520
Country	:	US
Telephone Number	:	404-630-4524
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 BUFORD HWY NE STE 190
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30329-2124
Country	:	US
Telephone Number	:	404-630-4524
Fax Number	:

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

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	02/19/2020

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