Provider Demographics
NPI:1457464224
Name:LOTTMAN, KAREN MICHELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:MICHELLE
Last Name:LOTTMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2484 SHATTUCK AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2076
Mailing Address - Country:US
Mailing Address - Phone:510-704-7480
Mailing Address - Fax:510-704-7494
Practice Address - Street 1:2484 SHATTUCK AVE
Practice Address - Street 2:STE 210
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:510-704-7480
Practice Address - Fax:510-704-7494
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA206511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6887Medicaid