Healthcare Provider Details

I. General information

NPI: 1831933290
Provider Name (Legal Business Name): ROCHELLE KOCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W WHITTIER BLVD
LA HABRA CA
90631-3610
US

IV. Provider business mailing address

2854 W TYLER AVE
ANAHEIM CA
92801-6265
US

V. Phone/Fax

Practice location:
  • Phone: 562-697-6030
  • Fax:
Mailing address:
  • Phone: 714-423-4558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW117624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: