Provider Demographics
NPI:1730191040
Name:KOH, BIBIANA D (LICSW)
Entity type:Individual
Prefix:DR
First Name:BIBIANA
Middle Name:D
Last Name:KOH
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 1:314 FRANKLIN AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1238
Mailing Address - Country:US
Mailing Address - Phone:410-973-2525
Mailing Address - Fax:
Practice Address - Street 1:314 FRANKLIN AVE STE 306
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1238
Practice Address - Country:US
Practice Address - Phone:410-973-2525
Practice Address - Fax:410-973-2527
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN193791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD256630OtherKAISER
MD64740701OtherBCBS OF MD
DCA2840159OtherBCBS OF DC
MD1892900Medicaid
MD825275000OtherMAGELLAN
MD7047783OtherAETNA