Healthcare Provider Details

I. General information

NPI: 1205432978
Provider Name (Legal Business Name): KAREN D KOCHENBURG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 MERIDIAN AVE STE D
SAN JOSE CA
95126-3425
US

IV. Provider business mailing address

PO BOX 28262
SAN JOSE CA
95159-8262
US

V. Phone/Fax

Practice location:
  • Phone: 408-800-1073
  • Fax:
Mailing address:
  • Phone: 408-634-3575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: