Provider Demographics
NPI:1962704429
Name:KOCHISS, JEFFREY FARLEY (LMFT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:FARLEY
Last Name:KOCHISS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2205
Mailing Address - Country:US
Mailing Address - Phone:203-437-2161
Mailing Address - Fax:
Practice Address - Street 1:555 HIGHLAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2205
Practice Address - Country:US
Practice Address - Phone:203-437-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001297106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid