MEDICARE: MS. KARY R. COTTER 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	1041C0700X	Clinical Social Worker	124837-3501	UT
2	1041C0700X	Clinical Social Worker	21877	CA

General Provider Information

NPI Number	:	1689610677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARY R. COTTER LCSW

Provider Business Mailing Address
First Line	:	12 REDONDO CT
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-1136
Country	:	US
Telephone Number	:	510-769-7848
Fax Number	:	510-769-7848

Provider Business Practice Location Address
First Line	:	6222 LA SALLE AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-2804
Country	:	US
Telephone Number	:	510-769-5144
Fax Number	:	510-769-6190

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	12/07/2012

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