Provider Demographics
NPI:1154484905
Name:STERN KUCHA, DOROTHY (LCSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:STERN KUCHA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3673 OTTER CREST LOOP
Mailing Address - Street 2:
Mailing Address - City:DEPOE BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97341-9779
Mailing Address - Country:US
Mailing Address - Phone:541-765-9891
Mailing Address - Fax:
Practice Address - Street 1:3673 OTTER CREST LOOP
Practice Address - Street 2:
Practice Address - City:DEPOE BAY
Practice Address - State:OR
Practice Address - Zip Code:97341-9779
Practice Address - Country:US
Practice Address - Phone:541-765-9891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL22381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
100796Medicare ID - Type Unspecified
OR210695Medicare ID - Type Unspecified