Provider Demographics
NPI:1972020600
Name:MORALES-KOCH, TAMMIE MARIE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:MARIE
Last Name:MORALES-KOCH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 FIOT AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-2758
Mailing Address - Country:US
Mailing Address - Phone:610-625-0733
Mailing Address - Fax:
Practice Address - Street 1:881 MARCON BLVD UNIT 3900
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-9379
Practice Address - Country:US
Practice Address - Phone:610-266-2656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133941104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker