Provider Demographics
NPI:1457400608
Name:KOCHER, CAROL BRINES (MSW)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:BRINES
Last Name:KOCHER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:BRINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:219 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-3105
Mailing Address - Country:US
Mailing Address - Phone:781-431-2277
Mailing Address - Fax:781-431-7770
Practice Address - Street 1:219 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-3105
Practice Address - Country:US
Practice Address - Phone:781-431-2277
Practice Address - Fax:781-431-7770
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1046771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
468849OtherVALUE OPTIONS
MA104677OtherTUFTS HEALTH PLAN
468849OtherVALUE OPTIONS
KOP21363Medicare ID - Type Unspecified