Provider Demographics
NPI:1942327606
Name:COTTER, JEFFREY A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:A
Last Name:COTTER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 18TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-2441
Mailing Address - Country:US
Mailing Address - Phone:415-431-1485
Mailing Address - Fax:415-276-2397
Practice Address - Street 1:1700 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-2918
Practice Address - Country:US
Practice Address - Phone:415-292-1500
Practice Address - Fax:415-292-2030
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS226391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
10632OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
10632OtherSFGH INTERNAL USE ONLY