Provider Demographics
NPI:1649341009
Name:KOTCHER, JEAN W (MA,MFT)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:W
Last Name:KOTCHER
Suffix:
Gender:F
Credentials:MA,MFT
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:JEAN
Other - Last Name:KOTCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:170 VALDEZ AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1323
Mailing Address - Country:US
Mailing Address - Phone:415-334-1805
Mailing Address - Fax:415-239-7424
Practice Address - Street 1:4214 18TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2410
Practice Address - Country:US
Practice Address - Phone:415-626-7945
Practice Address - Fax:425-239-7424
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25624106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist