Healthcare Provider Details

I. General information

NPI: 1518255611
Provider Name (Legal Business Name): BRIDGET MAUREEN KOCH-TIMOTHY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 CAPITOL AVE SUITE 201
SACRAMENTO CA
95816-5808
US

IV. Provider business mailing address

2509 CAPITOL AVE SUITE 201
SACRAMENTO CA
95816-5808
US

V. Phone/Fax

Practice location:
  • Phone: 916-587-1885
  • Fax:
Mailing address:
  • Phone: 916-587-1885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: