Provider Demographics
NPI:1033497300
Name:COTTER, CYNTHIA A (PHD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:COTTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12636 HIGH BLUFF DR STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2071
Mailing Address - Country:US
Mailing Address - Phone:619-992-4519
Mailing Address - Fax:866-703-8346
Practice Address - Street 1:12636 HIGH BLUFF DR STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130
Practice Address - Country:US
Practice Address - Phone:619-992-4519
Practice Address - Fax:866-703-8346
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24404103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical