Provider Demographics
NPI:1720579667
Name:COTTER, MARISSA ANN (MA, MFT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:ANN
Last Name:COTTER
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 JUANITA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1733
Mailing Address - Country:US
Mailing Address - Phone:714-321-9770
Mailing Address - Fax:
Practice Address - Street 1:3150 18TH ST STE 431
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2077
Practice Address - Country:US
Practice Address - Phone:415-944-9558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-26
Last Update Date:2018-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92301106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist