Provider Demographics
NPI:1730310368
Name:KOCH-SHERAS, PHYLLIS REBECCA (PHD)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:REBECCA
Last Name:KOCH-SHERAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5033
Mailing Address - Country:US
Mailing Address - Phone:434-971-4701
Mailing Address - Fax:434-973-3536
Practice Address - Street 1:211 W MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5033
Practice Address - Country:US
Practice Address - Phone:434-971-4701
Practice Address - Fax:434-973-3536
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000851103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical