Healthcare Provider Details

I. General information

NPI: 1083997845
Provider Name (Legal Business Name): THEANVY KUOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THEANVY KUOCH LPC

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 NEW BRITAIN AVENUE SUITE 202
WEST HARTFORD CT
06110-2440
US

IV. Provider business mailing address

1125 NEW BRITAIN AVENUE SUITE 202
WEST HARTFORD CT
06110-2440
US

V. Phone/Fax

Practice location:
  • Phone: 860-561-3345
  • Fax: 860-561-3538
Mailing address:
  • Phone: 860-561-3345
  • Fax: 860-561-3538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000638
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: