Provider Demographics
NPI:1740373554
Name:KOELSCH, DENISE MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:KOELSCH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 NEW BALCH ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2573
Mailing Address - Country:US
Mailing Address - Phone:978-969-2513
Mailing Address - Fax:978-969-2513
Practice Address - Street 1:121 NEW BALCH ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2573
Practice Address - Country:US
Practice Address - Phone:978-969-2513
Practice Address - Fax:978-969-2513
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1101351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1853562Medicaid
MA1853562Medicaid