Provider Demographics
NPI:1114964640
Name:EHST KOCH, RHODA (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:RHODA
Middle Name:
Last Name:EHST KOCH
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CAMBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964
Mailing Address - Country:US
Mailing Address - Phone:215-799-1949
Mailing Address - Fax:
Practice Address - Street 1:220 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964
Practice Address - Country:US
Practice Address - Phone:215-799-1949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW007746L1041C0700X
PACW0125991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50013435OtherCAPITAL BLUE CROSS
PAS28581Medicare UPIN
PA865669Medicare ID - Type Unspecified