=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396257713
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIEKE KOHL LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2017
-----------------------------------------------------
Last Update Date | 10/25/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 132 MASS MOCA WAY
-----------------------------------------------------
City | NORTH ADAMS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-664-4600
-----------------------------------------------------
Fax | 413-664-4660
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 132 MASS MOCA WAY
-----------------------------------------------------
City | NORTH ADAMS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-664-4600
-----------------------------------------------------
Fax | 413-664-4660
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 2027700
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------