Healthcare Provider Details

I. General information

NPI: 1962261958
Provider Name (Legal Business Name): NICOLE KOCH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W 70TH ST FRNT 1
NEW YORK NY
10023-4304
US

IV. Provider business mailing address

300 W END AVE # 9B
NEW YORK NY
10023-8156
US

V. Phone/Fax

Practice location:
  • Phone: 917-838-8008
  • Fax:
Mailing address:
  • Phone: 917-838-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: