Healthcare Provider Details

I. General information

NPI: 1780139774
Provider Name (Legal Business Name): TIFFANY KOCHER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY LIVINGSTON

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 DERBY ST STE 4
HINGHAM MA
02043-4021
US

IV. Provider business mailing address

175 DERBY ST STE 4
HINGHAM MA
02043-4021
US

V. Phone/Fax

Practice location:
  • Phone: 978-505-3783
  • Fax:
Mailing address:
  • Phone: 978-505-3783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118871
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: