Provider Demographics
NPI:1902124597
Name:KOCHER, MICHAEL BERNARD (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BERNARD
Last Name:KOCHER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 GOLF RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1224
Mailing Address - Country:US
Mailing Address - Phone:773-504-6005
Mailing Address - Fax:847-570-4911
Practice Address - Street 1:4711 GOLF RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1224
Practice Address - Country:US
Practice Address - Phone:773-504-6005
Practice Address - Fax:847-570-4911
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490141041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical