Doctor Name: | ELLEN B KOCH |
NPI Number: | 1013082320 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 002906 |
Business Practice Address: | River Valley Services Dutton Home Silver St Middletown, CT - 06457 |
Business Phone Number: | 8602625358 |
Business Fax Number: | 8602625356 |
Mailing Address: | River Valley Services, Dutton Home Silver St Po Box 351 MIDDLETOWN |
State: | CT |
Postal Code: | 06457 |
Phone Number: | 8602625358 |
Fax Number: | 8602625356 |
NPI Enumeration Date: | 11/21/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 002906 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |