Provider Demographics
NPI:1518255611
Name:KOCH-TIMOTHY, BRIDGET MAUREEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:MAUREEN
Last Name:KOCH-TIMOTHY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 CAPITOL AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5808
Mailing Address - Country:US
Mailing Address - Phone:916-587-1885
Mailing Address - Fax:
Practice Address - Street 1:2509 CAPITOL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5808
Practice Address - Country:US
Practice Address - Phone:916-587-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAPSY26734103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health