Healthcare Provider Details

I. General information

NPI: 1255440897
Provider Name (Legal Business Name): SARA CALIHAN KOCH M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 BEACON ST SUITE 6B
BROOKLINE MA
02446-3885
US

IV. Provider business mailing address

1180 BEACON ST SUITE 6B
BROOKLINE MA
02446-3885
US

V. Phone/Fax

Practice location:
  • Phone: 617-240-3483
  • Fax: 617-730-9845
Mailing address:
  • Phone: 617-240-3483
  • Fax: 617-730-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110666
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: