Provider Demographics
NPI:1700210531
Name:KOCH, AUBREY JACQUELINE (LCSW)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:JACQUELINE
Last Name:KOCH
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:PO BOX 781242
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-9242
Mailing Address - Country:US
Mailing Address - Phone:213-224-9466
Mailing Address - Fax:
Practice Address - Street 1:2120 COLORADO BLVD STE 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1255
Practice Address - Country:US
Practice Address - Phone:800-562-6382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA884701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical