MEDICARE: AMANDA R KOCH LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	102351	NY

General Provider Information

NPI Number	:	1336947175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA R KOCH LMSW

Provider Business Mailing Address
First Line	:	468 GLENWOOD AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14613-2243
Country	:	US
Telephone Number	:	585-402-6638
Fax Number	:

Provider Business Practice Location Address
First Line	:	468 GLENWOOD AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14613-2243
Country	:	US
Telephone Number	:	585-402-6638
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2025
Last Update Date	:	03/06/2025

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