Provider Demographics
NPI:1407490717
Name:KOCH, SHARON JEAN (EDD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:JEAN
Last Name:KOCH
Suffix:
Gender:F
Credentials:EDD, LCSW
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:JEAN
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 TOWNWOODS RD
Mailing Address - Street 2:
Mailing Address - City:IVORYTON
Mailing Address - State:CT
Mailing Address - Zip Code:06442-1269
Mailing Address - Country:US
Mailing Address - Phone:860-335-9013
Mailing Address - Fax:
Practice Address - Street 1:80 PLAINS RD
Practice Address - Street 2:UNIT 1
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06422
Practice Address - Country:US
Practice Address - Phone:860-754-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT71814257471041S0200X
CT106211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool