Healthcare Provider Details

I. General information

NPI: 1700286325
Provider Name (Legal Business Name): MARJORIE KOCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 NORTH FRONT STREET
HARRISBURG PA
17110
US

IV. Provider business mailing address

3333 NORTH FRONT STREET
HARRISBURG PA
17110
US

V. Phone/Fax

Practice location:
  • Phone: 717-233-1681
  • Fax: 717-234-8258
Mailing address:
  • Phone: 717-233-1681
  • Fax: 717-234-8258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: