Provider Demographics
NPI:1326868357
Name:KOTHE, HERMAN IV (LCSW)
Entity type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:
Last Name:KOTHE
Suffix:IV
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 1:4445 NORTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1556
Mailing Address - Country:US
Mailing Address - Phone:916-276-7713
Mailing Address - Fax:
Practice Address - Street 1:4445 NORTHAMPTON DR
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1556
Practice Address - Country:US
Practice Address - Phone:916-276-7713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical