Provider Demographics
NPI:1750503223
Name:POCH, TODD R (PSYD, MALD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:R
Last Name:POCH
Suffix:
Gender:M
Credentials:PSYD, MALD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 TURTLE CIR
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3806
Mailing Address - Country:US
Mailing Address - Phone:321-777-3359
Mailing Address - Fax:321-779-8793
Practice Address - Street 1:505 TURTLE CIR
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3806
Practice Address - Country:US
Practice Address - Phone:321-777-3359
Practice Address - Fax:321-779-8793
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2181103TC0700X
MNLP4368103TC0700X
FL5546103TC0700X, 103TF0200X
NM703103TF0200X
CO2094103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic