Healthcare Provider Details

I. General information

NPI: 1861339111
Provider Name (Legal Business Name): COLLEEN KOCIK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 WASHINGTON RD
WESTMINSTER MD
21157-5838
US

IV. Provider business mailing address

904 WASHINGTON RD
WESTMINSTER MD
21157-5838
US

V. Phone/Fax

Practice location:
  • Phone: 443-536-3239
  • Fax:
Mailing address:
  • Phone: 443-536-3239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33349
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: