Provider Demographics
NPI:1124614987
Name:DR JODI COOCHISE LLC
Entity type:Organization
Organization Name:DR JODI COOCHISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:COOCHISE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-674-0061
Mailing Address - Street 1:83 PAUL GORE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-1858
Mailing Address - Country:US
Mailing Address - Phone:303-807-1147
Mailing Address - Fax:
Practice Address - Street 1:399 BOYLSTON ST STE 900A
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3305
Practice Address - Country:US
Practice Address - Phone:617-674-0061
Practice Address - Fax:617-674-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty