Provider Demographics
NPI:1073637583
Name:COCO, MARY KAY (LCSW DSW)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KAY
Last Name:COCO
Suffix:
Gender:F
Credentials:LCSW DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 EAST 1050 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-1433
Mailing Address - Country:US
Mailing Address - Phone:801-359-4021
Mailing Address - Fax:801-359-4025
Practice Address - Street 1:1054 E 900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-1433
Practice Address - Country:US
Practice Address - Phone:801-359-4021
Practice Address - Fax:801-359-4025
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1293553501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health