Provider Demographics
NPI:1700949161
Name:GLENN R KOCH AND ASSOCIATES INC
Entity Type:Organization
Organization Name:GLENN R KOCH AND ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT LICENSED PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:610-266-0610
Mailing Address - Street 1:961 MARCON BOULEVARD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109
Mailing Address - Country:US
Mailing Address - Phone:610-266-0610
Mailing Address - Fax:610-266-0292
Practice Address - Street 1:961 MARCON BOULEVARD
Practice Address - Street 2:SUITE 312
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109
Practice Address - Country:US
Practice Address - Phone:610-266-0610
Practice Address - Fax:610-266-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005286L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016509210002Medicaid
PA02817200OtherCAPITAL BLUE CROSS
PAGL1454227OtherHIGHMARK BLUE SHIELD