Provider Demographics
NPI:1922441062
Name:KOTTRABA, CARIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARIN
Middle Name:
Last Name:KOTTRABA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11237 SIERRA PASS PL
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-1269
Mailing Address - Country:US
Mailing Address - Phone:818-998-0717
Mailing Address - Fax:
Practice Address - Street 1:11237 SIERRA PASS PL
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-1269
Practice Address - Country:US
Practice Address - Phone:818-998-0717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20265103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist