Provider Demographics
NPI:1780139774
Name:KOCHER, TIFFANY (LICSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:KOCHER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:LIVINGSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 DERBY ST STE 4
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4021
Mailing Address - Country:US
Mailing Address - Phone:978-505-3783
Mailing Address - Fax:
Practice Address - Street 1:175 DERBY ST STE 4
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4021
Practice Address - Country:US
Practice Address - Phone:978-505-3783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1188711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical