Healthcare Provider Details

I. General information

NPI: 1023959418
Provider Name (Legal Business Name): KATHLEEN COATTA LICENSED CLINICAL SOCIAL WORKER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1674 COOLIDGE AVE
ALTADENA CA
91001-3632
US

IV. Provider business mailing address

PO BOX 40503
PASADENA CA
91114-7503
US

V. Phone/Fax

Practice location:
  • Phone: 626-376-9575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN COATTA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 626-376-9575