Individual
CAROLYN BRADLEY KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., L.M.H.C.
Contact information
Practice address
3532 JAMES ST, SYRACUSE, NY 13206-2488
(315) 463-9413
Mailing address
3532 JAMES ST, SYRACUSE, NY 13206-2488
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
003135
NY
171M00000X
Case Manager/Care Coordinator
003135
NY
Other
Enumeration date
01/15/2007
Last updated
06/06/2018
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