Provider Demographics
NPI:1235211806
Name:KOCHKA, PATRICIA B (LMHC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:B
Last Name:KOCHKA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DENNIS PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02639-1310
Mailing Address - Country:US
Mailing Address - Phone:508-394-8881
Mailing Address - Fax:508-394-8881
Practice Address - Street 1:223 MAIN ST
Practice Address - Street 2:
Practice Address - City:DENNIS PORT
Practice Address - State:MA
Practice Address - Zip Code:02639-1310
Practice Address - Country:US
Practice Address - Phone:508-394-8881
Practice Address - Fax:508-394-8881
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1894714Medicaid