Provider Demographics
NPI:1164705950
Name:UTLEY, ELLEN KOCH (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:KOCH
Last Name:UTLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 SILVER SPRING RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-5417
Mailing Address - Country:US
Mailing Address - Phone:203-431-4948
Mailing Address - Fax:
Practice Address - Street 1:318 SILVER SPRING RD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-5417
Practice Address - Country:US
Practice Address - Phone:203-431-4948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175131101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional