Provider Demographics
NPI:1194945212
Name:DEPOTTEL, CAROLINE SCOTT (PHD LCSW)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:SCOTT
Last Name:DEPOTTEL
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5190 GOVERNOR DR
Mailing Address - Street 2:STE 102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2848
Mailing Address - Country:US
Mailing Address - Phone:858-455-0278
Mailing Address - Fax:858-452-5729
Practice Address - Street 1:5190 GOVERNOR DR
Practice Address - Street 2:STE 102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-2848
Practice Address - Country:US
Practice Address - Phone:858-455-0278
Practice Address - Fax:858-452-5729
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS10997103TP0814X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SW10997Medicare ID - Type Unspecified