Healthcare Provider Details

I. General information

NPI: 1003146838
Provider Name (Legal Business Name): MARGARET ELIZABETH KOCH MRC, LMHC, CAGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 JOHN CLARKE RD
MIDDLETOWN RI
02842-5641
US

IV. Provider business mailing address

69 ROCKY BROOK WAY
WAKEFIELD RI
02879-8120
US

V. Phone/Fax

Practice location:
  • Phone: 401-848-4184
  • Fax: 401-848-2336
Mailing address:
  • Phone: 401-952-8991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: