Provider Demographics
NPI:1053927392
Name:MORTIMER, KATHERINE CALDWELL (LCSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CALDWELL
Last Name:MORTIMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4188 S RIVIERA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-3141
Mailing Address - Country:US
Mailing Address - Phone:520-990-9220
Mailing Address - Fax:
Practice Address - Street 1:4188 S RIVIERA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80018-3141
Practice Address - Country:US
Practice Address - Phone:520-990-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099231511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical