MEDICARE: DR. CAROLINE SCOTT DEPOTTEL PHD 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	103TP0814X	Psychoanalysis Psychologist	LCS10997	CA
2	104100000X	Social Worker	LCS10997	CA

General Provider Information

NPI Number	:	1194945212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLINE SCOTT DEPOTTEL PHD LCSW

Provider Business Mailing Address
First Line	:	5190 GOVERNOR DR
Second Line	:	STE 102
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-2848
Country	:	US
Telephone Number	:	858-455-0278
Fax Number	:	858-452-5729

Provider Business Practice Location Address
First Line	:	5190 GOVERNOR DR
Second Line	:	STE 102
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-2848
Country	:	US
Telephone Number	:	858-455-0278
Fax Number	:	858-452-5729

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

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	09/11/2025

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Directions to “ DR. CAROLINE SCOTT DEPOTTEL PHD LCSW” Practice Location

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