Provider Demographics
NPI:1285752758
Name:DOTTER, KATHLEEN D (LICSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:D
Last Name:DOTTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LOVEREN LN
Mailing Address - Street 2:RT. 11D
Mailing Address - City:ALTON BAY
Mailing Address - State:NH
Mailing Address - Zip Code:03810-4042
Mailing Address - Country:US
Mailing Address - Phone:603-513-1620
Mailing Address - Fax:603-875-5022
Practice Address - Street 1:84 BAYSTREET
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894
Practice Address - Country:US
Practice Address - Phone:603-513-1620
Practice Address - Fax:603-875-5022
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010465Medicaid
NHRE6070Medicare ID - Type Unspecified