Provider Demographics
NPI:1568001469
Name:COTTER, MONICA ANNE (PSYD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ANNE
Last Name:COTTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 N JEFFERSON ST APT 303
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1250
Mailing Address - Country:US
Mailing Address - Phone:773-749-1124
Mailing Address - Fax:
Practice Address - Street 1:ADAM BENJAMIN JR. VA OUTPATIENT CLINIC
Practice Address - Street 2:9301 MADISON
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4630
Practice Address - Country:US
Practice Address - Phone:312-569-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010188103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical