Basic Information
| Provider Information | |||||||||
| NPI: | 1003146838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOCH | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MRC, LMHC, CAGS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 69 ROCKY BROOK WAY | ||||||||
| Address2: | |||||||||
| City: | WAKEFIELD | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028798120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4019528991 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 31 JOHN CLARKE RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028425641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018484184 | ||||||||
| FaxNumber: | 4018482336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2009 | ||||||||
| LastUpdateDate: | 01/06/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.