Individual
JACLYN KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
600 E 125TH ST, NEW YORK, NY 10035
(646) 672-5864
Mailing address
600 E 125TH ST, NEW YORK, NY 10035-6000
(646) 672-5864
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
019936-1
NY
103TF0200X
Forensic Psychologist
—
—
Other
Enumeration date
06/13/2014
Last updated
08/26/2018
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