MEDICARE: TIFFANY KOCHER, LICSW PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1437730363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIFFANY KOCHER, LICSW PLLC

Provider Business Mailing Address
First Line	:	175 DERBY ST STE 4
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-4021
Country	:	US
Telephone Number	:	978-505-3783
Fax Number	:	617-404-3302

Provider Business Practice Location Address
First Line	:	175 DERBY ST STE 4
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-4021
Country	:	US
Telephone Number	:	978-505-3783
Fax Number	:	617-404-3302

Authorized Official
Title or Position	:	OWNER
Name	:	TIFFANY KOCHER
Credential	:	LICSW
Telephone Number	:	978-505-3783

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	04/21/2021

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