MEDICARE: DR. NANCY KAY OTTERNESS PHD CLINICAL PSYCHOL

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	103T00000X	Psychologist	12125	CA
2	104100000X	Social Worker	2418	CA
3	106H00000X	Marriage & Family Therapist	13850	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861683773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY KAY OTTERNESS PHD CLINICAL PSYCHOL

Provider Business Mailing Address
First Line	:	1005 40TH STREET
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3612
Country	:	US
Telephone Number	:	916-453-1172
Fax Number	:	916-453-8661

Provider Business Practice Location Address
First Line	:	1005 40TH STREET
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3612
Country	:	US
Telephone Number	:	916-453-1172
Fax Number	:	916-453-8661

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

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	10/13/2011

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