Provider Demographics
NPI:1083997845
Name:KUOCH, THEANVY
Entity Type:Individual
Prefix:
First Name:THEANVY
Middle Name:
Last Name:KUOCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THEANVY
Other - Middle Name:
Other - Last Name:KUOCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1125 NEW BRITAIN AVENUE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-2440
Mailing Address - Country:US
Mailing Address - Phone:860-561-3345
Mailing Address - Fax:860-561-3538
Practice Address - Street 1:1125 NEW BRITAIN AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2440
Practice Address - Country:US
Practice Address - Phone:860-561-3345
Practice Address - Fax:860-561-3538
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000638101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional