Provider Demographics
NPI:1619125119
Name:COTTER, CAITLIN MARA (LICSW)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MARA
Last Name:COTTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 S WELLER ST
Mailing Address - Street 2:APT. #B
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2205
Mailing Address - Country:US
Mailing Address - Phone:801-597-3179
Mailing Address - Fax:
Practice Address - Street 1:1200 12TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2712
Practice Address - Country:US
Practice Address - Phone:206-326-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 603377341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical