Provider Demographics
NPI:1366572273
Name:BUNNELL CODDINGTON, KAY I (LCSW, ACSW)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:I
Last Name:BUNNELL CODDINGTON
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S EL CAMINO REAL
Mailing Address - Street 2:STE. 204
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-1726
Mailing Address - Country:US
Mailing Address - Phone:650-872-0603
Mailing Address - Fax:650-343-8244
Practice Address - Street 1:520 S EL CAMINO REAL
Practice Address - Street 2:STE. 204
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-1726
Practice Address - Country:US
Practice Address - Phone:650-872-0603
Practice Address - Fax:650-343-8244
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical